Pacifico Family Foundation Scholarship Awards

2022 Scholarship Recipient Information Form

Please provide information for each recipient using the form below. Remember: each scholarship must be distributed in the minimum amount of $1,750 per student.

School Name*
Number of Recipients Chosen*
Please enter a number from 1 to 4.

RECIPIENT 1
Name*
First Last
(Middle name optional)
Email
Phone
Home Address
Street Address Address Line 2 City State ZIP Code
Scholarship Amount*
Please enter a number from 1750 to 7000.
Minimum scholarship is $1,750 per student.
Plans after high school:*
Will any family members attend the awards ceremony on May 10 at 10:00am at Pacifico Ford?*
Yes
No
Family members are encouraged to attend!
How Many?

RECIPIENT 2
Name*
First Last
(Middle name optional)
Email

Phone
Home Address
Street Address Address Line 2 City State ZIP Code

Scholarship Amount*
Please enter a number from 1750 to 7000.
Minimum scholarship is $1,750 per student.
Plans after high school:*
Will any family members attend the awards ceremony on May 10 at 10:00am at Pacifico Ford?*
Yes
No
How Many?

RECIPIENT 3
Name*
First Last
(Middle name optional)
Email

Phone
Home Address
Street Address Address Line 2 City State ZIP Code

Scholarship Amount*
Please enter a number from 1750 to 7000.
Minimum scholarship is $1,750 per student.
Plans after high school:*
Will any family members attend the awards ceremony on May 10 at 10:00am at Pacifico Ford?*
Yes
No
How Many?

RECIPIENT 4
Name*
First Last
(Middle name optional)
Email

Phone
Home Address
Street Address Address Line 2 City State ZIP Code

Scholarship Amount*
Please enter a number from 1750 to 7000.
Minimum scholarship is $1,750 per student.
Plans after high school:*
Will any family members attend the awards ceremony on May 10 at 10:00am at Pacifico Ford?*
Yes
No
How Many?

Guidance Counselor/School Contact Information
Name*
First Last
Email*

Phone*
Will school representative(s) attend the awards ceremony on May 10?*
Yes
No
A school representative must be onsite to accept the check. Please remember all checks are made out directly to the respective school/scholarship fund and then each school/scholarship fund is to distribute the scholarship funds accordingly to each student.
How Many?
Name of school's local newspaper

2022 Scholarship Recipient Information Form

RECIPIENT 1

RECIPIENT 2

RECIPIENT 3

RECIPIENT 4

Guidance Counselor/School Contact Information