EmailMe Form - SE Region 2024/25 Sponsor Company Addendum

SPONSOR COMPANY ADDENDUM
Sponsoring Company Representative *
Name of the sponsoring company representative
Sponsoring Company *
Name of the sponsoring company
Applicant Name *
Name of the applicant being sponsored for the 2024-2025 Abe Brenner & Ken Iverson scholarship
Donation Agreement *
Should the Applicant Name entered above be selected for the scholarship we agree to submit a non-refundable scholarship donation of $500 due upon scholarship recognition.
The Sponsoring Company’s $500 donation will be added to the Region’s contribution of $750, bringing the total scholarship to $1,250.
Sponsoring Company Representative
Name *
First Last
Email *
Phone *
### - ### - ####
Please provide the contact information for the Accounts Payable Department at the Sponsoring Company below.
Accounts Payable Primary Contact
Name *
First Last
Email *
Phone *
### - ### - ####
You will be notified by email if your sponsored applicant has been selected and will be given further instructions on when and where to submit your $500 payment. Thank you for your participation!

Please note: Donations are NOT tax deductible per the IRS.