Scholarship Recipient Information Release Form

  Congratulations on receiving your scholarship/award! MCCC would like to send out a press release. Please fill out the information below and return it to The Foundation at MCCC Office as quickly as possible. When listing clubs, organizations, and awards, please be as specific as possible, spelling out all acronyms. Thank you!
   
  Please provide the following information:
* - All information is required.
   
  Name of Scholarship/Award:  
  Name:  
  Address:  
  City/State/Zip:  
  Phone Number:  
  Email Address:  
  New MCCC Student    Current MCCC Student 
  Intended Major:  
  High School and Year of Graduation:  
  Local Newspaper:  
  If you have been out of high school for more than two years, please list your most recent activities in MCCC Clubs (or other college) and/or community organizations as well as MCCC (or other college) and/or community awards. Any volunteer activity is pertinent. Please be specific and spell out acronyms.
  School Clubs and/or Community Organizations:
 
  School and/or Community Awards:
 
  Parents and/or Spouse/Children (Please indicate which):
 
     
    Please Note: Please send a digital photo (head shot, not full body shot) to Donna Novak via email at czarb@monroeccc.edu , with your name and Scholarship/Award name.
  I will email photo         I will send photo regular mail (address below)
   
  Today's Date: (MM/DD/YYYY)
      
                               
The Foundation at Monroe County Community College
1555 South Raisinville Rd.
Monroe, MI 48161
734-384-4206