Scholarship Disbursement Request

This is for Youth Rally scholarship recipients to request their disbursement. The funds are sent directly to the institution.

Name(Required)

First Last

Student ID Number(Required)

Phone(Required)

Email(Required)

Year Awarded

If you aren't sure, please enter your best guess. If you attended more than once, please enter both years.

Amount Awarded

If you aren't sure, please leave blank.

Please enter the post-secondary institution you will be attending. Funds will be disbursed directly to them.

Name of Institution

Scholarship Disbursed to Any Accredited College, University, Trade School, or other Post-Secondary Education Institutions

Department of Office to Receive Funds

For example, Office of Financial Aid, Registrar or other such office. If you're not sure what to enter here, please type "Not Sure."

Institution's Address

Street Address City State / Province / Region ZIP / Postal Code Country

Proof of Enrollment(Required)

Max. file size: 100 MB.

Any proof of enrollment will work including: Class Schedule with your name on it, registration letter or other.