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CAISSA Application 2017
CAISSA Application 2017
Contact Information:
Tim Searcy, Scholarship Committee
2801 Hwy 280 South
Birmingham, AL 35223
Email: tim.searcy@protective.com
Phone: (205) 268-5289
2016-2017
Please check your degree level and write-in your major you are currently pursing
Current Class Status: Current GPA: ___________ (must be verified by a UAB advisor)
Is a member of your immediate family (spouse and/or children) a CAISSA Board Member or on the
Leadership team? Yes No
Are you currently working? Yes No Name of employer:_____________________________
*Some employers offer tuition benefits. Please check with your employer’s benefit department to find out if you qualify for
these benefits.
CERTIFICATION
I hereby certify that the information provided on this scholarship application is true and that I personally composed the
essay included herein. I grant permission to release information from my educational and financial records to scholarship
donors. If awarded a scholarship, I grant permission to my college or university and the scholarship donor to issue news
releases.