SYSTEM OFFICES STAFF SCHOLARSHIP PROGRAM
(Admission to an Institution of Higher Education must be completed and approved
by the application deadline.)
Semester:______________________________
Name:________________________________ SS#:__________________________________
Department:___________________________ Mail Stop:_____________________________
E-Mail Address:________________________ Phone #:______________________________
Will the class meet during regular working hours? Yes____ No____ (If no, departmental approval is not required)
____________________________
Employee's Signature
____________________________
Date
DEPARTMENTAL APPROVAL
Arrangements to account for time off from regular workweek to attend classes:
______ Will utilize vacation time
______ Will utilize flex time
______ Will take compensatory time
______ Will take leave without pay
Arrangements for time off to attend classes are acceptable and class attendance will not interfere with the accomplishments of duties or the work of the department.
___________________________
Department Reviewed and Approved
___________________________
Date
Scholarship Committee Only:
Date Received: ________________________ Approved: ____________________________
Date Funded: _________________________ Funding Amount: _______________________