Student Scholarship Application

Media City CU Account # *

First Name *

Middle Initial

Last Name *

Street Address *

City *

Enter ZIP Code *

Mobile Phone *

Parent or Guardian Full Name *

Student Email Address *

High School Name *

In August , I will be a:

College Freshman

College Sophomore

Community Involvement – Credit Unions make a difference in the lives of its members; we’d like to know how you are making a difference!

*

Educational Goals/Objectives & Major – Tell us about yourself and where you are headed!

*

This form offers an upload feature for both a file and for an image, or you can mail your documents to:

Media City Credit Union

Attn: Scholarship Committee

1020 W. Olive Avenue

Burbank, CA 91506

Upload your Letter of Recommendation

Acceptable file types are .pdf, .docx, .doc, .odt, .rtf, .txt.

Letter of Recommendation file:

Click or drag & drop file here to upload

Letter of Recommendation Image:

Click or drag & drop image here to upload

Upload your College Verification Document

Acceptable image types are: .png, .jpg, .jpeg.

College Verification File:

Click or drag & drop file here to upload

College Verification Image:

Click or drag & drop image here to upload

Statement of Intent

I certify that the information within this application is true, complete, and accurate. Furthermore, I authorize the release of information to confirm and/or verify this application.

I authorize permission for use of my name and photograph in press releases, social media platforms and other communication materials.

I agree to the Statement of Intent and submit my application.

Thank You