If you are graduating, Congratulations! Please complete and return this form. (2018 – 2019) Name Last * (last) First * (first) Middle Intial (middle initial) Address Number and Street (number and street) City (city) State (state) Zip Code (zip code) Student ID # Email Phone The Governor’s Cup Scholarship Program rules require recipients to annually file a statement of intent to continue as a full-time undergraduate student. Please complete this questionnaire and return it to the program manager no later than January 30th. I intend to enroll Fall 2018 I intend to enroll Fall 2018 Institution Institution Name Institution (city) (city) Institution (state) (state) Institution (zip) (zip) Major Anticipated Graduation Date I do not intend to enroll in 2018 – 2019 due to one of the following: I do not intend to enroll in 2018 – 2019 due to one of the following: Reason Graduation End of Eligibility Requesting Leave of Absence or Suspension (Must submit letter explaining by January 30th due date) Other (please explain) Other SELECTION CRITERIA Current Grade Point Average Cumulative Grade Point Average Grade Level in Fall 2018 Grade Freshman Sophomore Junior Senior Recipient’s Signature Recipient’s Signature Date Date Send completed form to: Sarah Bettwieser, Executive Director Idaho Governor’s Cup Scholarship Fund, Inc. PO Box 983 Boise, ID 83701 sarah@idahogovernorscup.org 208-713-9466 Please include a paragraph below highlighting your college experience and accomplishments. We will use these updates when promoting our scholarship program. Academic Highlight
