Scholarship Gap Year Notice Form
Notify the scholarship office about your intention to take a gap year and acknowledge the impact on your scholarship status.
Full Name
*
First Name
Last Name
Student Email Address
*
example@example.com
Student ID Number
*
Academic Program or Major
*
Current Scholarship Name
*
Gap Year Start Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Gap Year End Date (Expected)
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Reason for Taking a Gap Year
*
Do you understand that taking a gap year may affect your scholarship eligibility or status?
*
Yes, I understand
No, I do not understand
Signature (Draw your signature to confirm this notice)
*
Submit Notice
Submit Notice
Should be Empty: