MCCCD PRESIDENTS’ SCHOLARSHIP DEFERMENT APPLICATION

Name: ______Student 8 digit ID#: ______

(Last, First, M.I.)

Address: ______

(Street, City, State, Zip Code)

Phone Number: ______

(Include area code)

Maricopa Email Address: ______

Period requested for deferment: ______to ______

(Semester Start month/year) to (Semester End month/year)

Remember you may only request up to 4 full semesters. You may not request partial semesters, except in the case of a leave of absence due to an emergency/illness beyond your control that prevents you from completing the current semester (remember, however, that the scholarship is only for 4 semesters total. Once a scholarship has funded for the semester, it counts as one of the semesters, unless the student repays that semester’s scholarship). Deferment is only possible if a student is still eligible for future semesters. Requested time must correlate with the time frame of the activity that is preventing you from the requiredcontinuous enrollment at the Maricopa Community Colleges.

Semester you anticipate returning to a Maricopa Community College: ______(Semester and Year)

Please contact your Honors Program Faculty Director before the start of the semester you intend to return.

Reason for deferment request: (Please attach additional written documentation of circumstances necessitating the deferment of your scholarship, e.g., student letter of intent, letter from physician, program coordinator, religious official, etc.).

______

CERTIFICATION

I understand and agree to the following stipulations relative to the deferment of my scholarship:

  • I must be admitted to CGCC and the CGCC Honors program before submitting a deferment.
  • In most cases, I must have successfully completed a semester (not including summer). Exceptions must be approved by the Honors Director.
  • I must return to a Maricopa Community College the semester immediately following the deferment period.
  • I must inform the Honors Director in writing of any alterations of circumstances relative to the deferment or risk losing that deferment.
  • I may receive only one Presidents’ Scholarship deferment that cannot exceed two academic years (four consecutive fall and spring semesters).
  • I understand that submission of this request does not guarantee deferment.

______

SignatureDate

For office use only: Approved Denied Reason for Denial

Director’s Signature ______Date ______