Scholarship Choice Form
Hidden Fields
Student Contact ID
Redirect to disbursement?
Yes
No
Student Full Name (for Account lookup)
Matchforce Match ID
Scholarship Fund Close Date
Matchforce Grant Affiliation ID
Matchforce Little Contact ID
Matchforce Match ID
Scholarship Fund Close Date
Current Status
Please complete this form to request a Scholarship payment. Incomplete information may delay the processing of your
request. You should complete a new Choice Form for each semester.
First Name
Last Name
Name of Institution
Other Institution
School Type
Current Major
Other Major
Student ID
Number of Hours Enrolled
Please select...
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Other
FT/PT
Birthdate
High School Graduation Year
Please indicate the
semester
for which you are requesting funds:
Fall
Winter
Spring
Summer
Academic Year
Upload proof of enrollment:
EXAMPLES OF PROOF HERE
Does scholarship recipient consent to media release?
Yes
No
Please verify with your institution that the information you provide below is correct.
Name of Office:
City/State/Zip:
Office Phone:
Amount of scholarship to be used:
$
Full-time (12+ credits) - up to $500, Part-time (11 or less credits) - up to $250
Purpose of funds
Please select...
Tuition/fees
Books/supplies
Campus housing
Questions via email: Scholarship@bigmentoring.org or via telephone at 512-807 3642. You may fax this form to
512-472-5460 or mail to: BBBS Scholarship Administration, P.O. Box 4555, Austin, TX 78765.
Signature
Date
Permanent Address
City
State
Zip
Email Address
Cell Phone
Home Phone
Work Phone
Note: Check with BBBS to determine your deadline for use of Scholarship funds
Contact Information