Elaine Parry FCA Scholarship

Recipient Contact Information Form

Please complete the form below at your earliest convenience.

Elaine Parry FCA Scholarship Recipient Contact Information Form

Recipient Name

Phone #

Email Address

College Attending

Student ID#

Field label

Address

Phone #

Financial Aid Office Email Address

Field label

Names

Phone #s

Email Addresses

Home Address

Field label

College Address (Your dorm or apartment)

Phone #

College Email Address (Your new student email address)

Tell us About Your Future Plans/Studies

Will you continue your athletic career in college? (if so, what sport?)

I hereby assign the rights and give consent for my likeness in a photograph or video and/or voice on videotape or audiotape to be used by the Fellowship of Christian Athletes and their representatives for the purpose of illustration, web, editorial, advertising or distribution. I have read the above authorization, release and agreement and I am fully familiar with the contents thereof.

Yes

Please attach a senior photo to be used on our website and Senior Spotlight socials.

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Contact Info

1800 46th St NE, Cedar Rapids, IA 52402, United States

(319) 832-1461

easterniowa@fca.org

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