200 Farrington Street
Terre Haute, IN, 47807
Phone: 812-237-2547
Fax: 812-237-8705

Open:
Monday - Friday
7:15 AM - 5:15 PM

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CCAMPIS Scholarship Application

Date Submitted:

ISU Student's Name:

Student's Email Address:

Student ID Number:

ISU Status:

Child's Name:

Child's Date of Birth (mm/dd/yyyy):

Spouse's Name:

Spouse's ID Number:

Spouse's ISU Status:

Which semester are you applying for?

Are you eligible to receive a Peil grant for the 2011-2012 academic year? Yes No

What was your expected family contribution (EFC) for the current academic year?

Comments or additional information:

To submit this application, please do one of the following:

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