Scholarship Certification Form 2023-2024

NJIT ID or UCID *

Some scholarships require yearly certification in order to retain eligibility for multiple reasons. As a recipient of one of these scholarships, you will be required to yearly certify eligibility to ensure that you continue to meet the requirements requested by the donor/company. Please complete the personal information section below and the special circumstance information that is applicable to your scholarship. Please note that if not received scholarship(s) will be canceled.

First Name *

Last Name *

Special Circumstances

Please check the box of the circumstance that is applicable to your scholarships and complete the required information

Internship/Co-op Consideration

I certify that I am willing to consider an internship/Co-op with the company/donor related to my scholarship for the 2023-2024 academic year

Involved in extracurricular activities including community service and/or sports

I certify that I will participate in extracurricular activities for the 2023-2024 academic year

Employment Status

I certify that I am/will be employed at least part-time for the 2023-2024 academic year

I certify that I will not be employed for the 2023-2024 academic year

Print Signature (Student's Name) *

Date

04-25-24

Leave this field blank