Roughrider Scholarship Award Funds Request Form

First Name *

Middle Name

Last Name

Email Address *

Cell Phone *For text messages regarding awards

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Fall 2023Spring 2024Please select only one.

Name of College *Name of college and location where scholarship funds are to be sent.

College ID *ID of college where scholarship funds are to be sent.

Upload Proof of Registration *

No file chosen

Schedule, registration for the semester selected above.

Additional Information *If none, type "None"

Your current college major and career plan. *