Calistoga High School NEW Local Donor Form
Please complete and submit to Carla Surber in the College & Career Center by January 20, 2017. If you have questions, you can reach Carla at 942-6278 ext. 2650, or 707 315-9908.
Scholarship Details
Name of Scholarship(s):
Your answer
Number of Scholarships:
Your answer
Scholarship Amount(s):
Your answer
Please check one:
Contact Information
Contact Person:
Your answer
Mailing Address:
Your answer
Email:
Your answer
Phone:
Your answer
Criteria for selection:
For example, minimum grade point average; leadership; financial need; particular field of study or interest; and community service.
Please list criteria:
Your answer
Disbursement of Funds & Presentation of Award
Note: It is the recipient's responsibility to supply the donor with all contact information, including financial aid office for school he/she is attending. The recipient must also show proof of verification of enrollment in college/trade school for funds to be disbursed.
Please check one:
Is this scholarship renewable?
Who will present the scholarship at the awards ceremony?
Name of person presenting award:
Your answer
Email:
Your answer
Mailing Address:
Your answer
Phone:
Your answer
Application Materials
Please send specific application forms or other materials to:

Carla Surber
Calistoga Jr/Sr High School
College & Career Center
1608 Lake Street
Calistoga, CA 94515

Fax to 707 942-6592, or email as an attachment to: csurber@calistogajusd.org

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