Audrey B. Mastroianni College Scholarship - Eligibility Questionnaire

   Have you lost a parent to or have a parent diagnosed with breast cancer?
    (If no, you do not qualify for this program.)
   Are you currently enrolled in college? (You must be enrolled and have a tuition bill issued, that we can help with.)
   Do you have medical documents stating the diagnosis/loss? (This will be required later.)
   Are you able to provide supporting documents (i.e. medical records, income verifcation, bills, etc) online as attachments with your application? This is Required.
   At the time of application (Not Now), Can you make the required $50.00 Pay-It-Forward-Contribution online? This contribution will assist others in need of UBCF services. (This is required.)
If the answer is no to any of the questions above, please provide a detailed explanation.
First Name
Last Name
Date of Birth
Phone
Email
Verify/Retype Email
Zipcode
City/State  
How did you hear about UBCF?