allen dom 1 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 AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code STUDENT CLASS LEVEL – Fall 2023 semester(Required)FreshmanSophomoreJuniorSeniorMAJOR(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 AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific 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) First Last FINANCIAL AID EMAIL(Required) I’m not finished with this form. I need to return later and finish. Please save my work and take me to my institution’s form dashboard.