Fields marked with an * are required

Team Member Transfer/Termination Form

If a Team Member has applied for the Chick-fil-A Remarkable Futures Scholarship, and has since transferred or terminated his/her employment with Chick-fil-A, please complete and submit the form below to notify Scholarship America. Team Members who terminate employment before the time of award are no longer eligible to receive a scholarship and will be notified of his/her ineligibility.

*If a Team Member has transferred and you have not awarded the Team Member, please work with their new Operator to present the award.

Operator/Manager First and Last Name *

Location Name *

Location City *

Location State/Province *

Country *

Operator/Manager Email *

Operator/Manager Cell Phone *

Team Member First and Last Name *

Registration ID # *

Team Member Status *

Terminated employment with Chick-fil-A

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If Team Member has terminated employment with Chick-fil-A, provide date of termination below.

Date of Termination

Have you presented the Team Member their award? *