American Netherland Dwarf Rabbit Club

Proof of Enrollment Form

American Netherland Dwarf Rabbit Club (ANDRC) Scholarship

Applicant name code: / Click here / (For use by Scholarship Committee only.)
IMPORTANT FOR APPLICANT: Make sure that you read the “Application Procedures and Advice” document found on the ANDRC website before preparing and transmitting this form and, if possible, email it to the Post-Secondary School designated official. If not possible, have someone email it for you.
As a recipient of an ANDRC scholarship, I have filled out my signature and the date and sections 1 and 2 of this form and I hereby request that you, as my Post-Secondary School designated official, fill out the remainder of this form and email it in accordance with the directions given below.
Click here to enter text. / Click here to enter text.
Signature of Applicant / Date
(May be typed due to submitting by email)
Sections 3 through 11 of this form are to be filled out by the Post-Secondary School designated official and emailed to: (Subject: ANDRC Scholarship). There is no deadline date but this form must be received at this email address before the ANDRC Scholarship money can be awarded.
1. Name of recipient:
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Last / First / Middle
2. Address of recipient:
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Street / City / State, Zip Code
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Email address / Home phone number / Cell phone number
3. Entrance date of recipient to this Post-Secondary School: / Click here to enter text.
4. Name of Post-Secondary School:
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5. Address and other information needed to send a check to this Post-Secondary School:
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Street, Building, Office or room number, C/O name, etc.
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City / State / Zip Code
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Email address / Phone number and extension
6. To be eligible to receive the ANDRC Scholarship money, this recipient must be a full-time student currently enrolled and actively attending, as of this date, an accredited two or four year College/University or Vocational School. Is this recipient eligible under this provision?
Yes/No: / Click here to enter text. / If No, explain below. If Yes, enter N/A below.
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7. In your judgment, are there any reasons of any kind other than the eligibility requirement in 6 above that makes this recipient unworthy of receiving the scholarship money?
Yes/No: / Click here to enter text. / If Yes, explain below. If No, enter N/A below.
Click here to enter text.
8. Please provide the recipient’s Student ID Number here: / Click here to enter text.
9. Name of person filling out this form: / Click here to enter text.
10. Title of person filling out this form: / Click here to enter text.
11. Signature of person filling out this form:
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(May be typed due to submitting by email) / Date (Mo/Day/Year)

Page 1 Proof of Enrollment Form (April 15, 2014) P Proof Proof of enrollment Form