SCHOLARSHIP AWARD INFORMATION AND AGREEMENT

Please complete and forward the following information to help us process your award which will be directly sent to your academic institution’s financial aid office based on information you provide.

Scholarship Recipient Name:

First Name

Last Name

Email

If Under 18, Parent/Guardian Name:

First Name

Last Name

College/University Info

College Student I.D. Number (Note: VERY IMPORTANT):

Name of College/University:

College/University’s Financial Aid Office Mailing Address:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

College/University’s Financial Aid Office Phone Number:

(###)

###

####

College/University’s Financial Aid Office email:

Award Agreement, Terms, and Conditions

This form serves as an agreement of the terms and conditions of the award. It is agreed between the Traverse City Track Club (grantor) and scholarship recipient (grantee) that: The Grantee will use the funds only for educational purposes specified and not for any other purpose that does not meet the Internal Revenue Service code provisions for charitable, educational, and scientific purposes. Scholarship funds will be disbursed by the Grantor to the post-secondary education institution indicated by the Grantee (below). Funds will be disbursed the first week of August. The Grantee will notify the Traverse City Track Club if they withdraw from their institution, are expelled from their institution, or enroll at a different educational institution. This scholarship is from the Traverse City Track Club, a 501(c)(3) organization. If you have not contacted the Traverse City Track Club to make arrangements for your designated scholarship funds by December 15, 2019 all allocated award money will revert back to the Traverse City Track Club.

Grantee agrees to the terms and conditions of the award as received above

Scholarship Grantee:

First Name

Last Name

If under 18, Parent/Guardian Name:

First Name

Last Name

By submitting this form, I acknowledge (or a parent or adult guardian for all children under 18 years) having read and agreed to the above agreement.

Yes