SCICU SCHOLAR PROGRAM

COLLEGE		YEAR
Allen University		2023-2024
TYPE		AMOUNT
SCICU SCHOLAR		$1,000
DONOR NAME
Dominion Energy Charitable Foundation
DONOR CONTACT		CONTACT TITLE
Ms. Stephanie Jones		Community Affairs
DONOR ADDRESS	DONOR CITY	DONOR STATE	DONOR ZIP
220 Operation Way, MC B227	Cayce	SC	29033-3701

DONOR CRITERIA
Award is available for one year only. The student, parent, or guardian must be a current customer of Dominion Energy. Verification is required. The recipient must be a traditional full-time student with GPA of 3.0 or higher. A STEM-related major is preferred but not required.

STUDENT NAME (First and Last Required)

First Name(Required)

Middle

Last(Required)

Suffix

STUDENT SCHOOL ADDRESS(Required)

Street Address City State ZIP Code

STUDENT CLASS LEVEL – Fall 2023 semester(Required)

MAJOR(Required)

STUDENT GPA(Required)

STUDENT EMAIL ADDRESS(Required)

STUDENT PERMANENT / HOME ADDRESS (exactly as the address appears on the Dominion bill)(Required)

Street Address City State ZIP Code

NAME OF PARENTS / GUARDIAN (exactly as the name(s) appear(s) on the Dominion bill)(Required)

When submitting this scholarship form to SCICU, the financial aid director certifies they have informed the above-named student that their acceptance of this scholarship requires granting permission to SCICU, their school, and the scholarship donor to use their name, photo, and related information in press releases and other public relations materials.

FINANCIAL AID DIRECTOR NAME(Required)

FINANCIAL AID EMAIL(Required)

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SCICU SCHOLAR PROGRAM