Calistoga High School Local Donor Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please complete and submit to Carla Surber in the College & Career Center by February 28, 2025. If you have questions, you can reach Carla at 942-6278 ext. 2650, 707 315-9908, or csurber@calistogajusd.org

Scholarship Details

Name of Scholarship(s):

Number of Scholarships:

Scholarship Amount(s):

Please check one:

I would like to be contacted to make the final decision for this scholarship (we will send you all applications that fit criteria).

I will leave the final decision up to the Calistoga High School Scholarship Committee

Other:

Clear selection

Contact Information

Contact Person:

Mailing Address:

Email:

Phone:

Criteria for selection:

For example, minimum grade point average; leadership; financial need; particular field of study or interest; and community service.

Please list criteria:

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:

Money will be sent directly to recipient of award and correspondence will take place between the donor and recipient.

Money will be sent to CJUSD and correspondence will take place between CJUSD and the recipient or financial aid office.

Other:

Clear selection

Is this scholarship renewable?

Yes

Clear selection

Who will present the scholarship at the awards ceremony?

I would like to present this scholarship to the senior(s) during Senior Awards Night in May.

Please have a member of the CHS community present on my/our behalf.

Other:

Clear selection

Name of person presenting award:

Email:

Mailing Address:

Phone:

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

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Calistoga Joint Unified School District.

Does this form look suspicious? Report

Forms