Please complete the following questions to claim your ECMC College Nights scholarship award.
Questions? Email collegenights@ecmc.org.

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* 1. First name

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* 2. Last name

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* 3. Phone number

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* 4. Email address

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* 5. Parent/guardian email address

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* 6. High school where you won your award

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* 7. College name

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* 8. College address where scholarship check should be sent (If you are unsure, check your college's website and/or contact the Financial Aid Office.)

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* 9. College student ID number

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* 10. Which academic year are you requesting a disbursement for?

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* 11. Which term are you requesting a disbursement for?

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* 12. Upload evidence of enrollment for the term that you want the scholarship funds to be applied. The document must include your first and last name, college name and term preprinted on it. Examples include:
  • Copy of your class schedule 
  • Copy of your tuition bill
  • Enrollment verification form from your college

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