St. Ursula Academy Scrip Program Registration

Participant Name(s) __________________________________________________________

Address ____________________________________________________________________

City _____________________________  State _______________  Zip__________________

Home Phone (    ) __________________  Work Phone (    ) __________________________

Email Address for Scrip Correspondence _________________________________________

Student’s First Name: ________________ Student’s Last Name:___________________  Graduation Yr:_____

Student’s First Name: ________________ Student’s Last Name:___________________  Graduation Yr:_____

Student’s First Name: ________________ Student’s Last Name:___________________  Graduation Yr:_____

Amount of earnings will be credited equally to the above named tuition accounts.

Participant has read, does understand, and will abide by the general policies of the St. Ursula Academy Scrip Program.  The participant further understands that email will be the official method of communication of the St. Ursula Academy Scrip Program.  All official correspondence will be distributed from the email address scrip@toledosua.org.

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Signature

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Printed Name

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Date

After your registration form is submitted, scrip orders may commence.

We recommend submitting your registration forms with your first check!