Great Grades Redemption

By signing this Great Grades Rewards redemption form, you are affirming that all information provided is accurate, true and correct. If any information provided is found to be incorrect or cannot be verified, forfeiture of any Great Grade Rewards received may occur. I also affirm I have read and agree to the Electronic Signature Terms.

Special note to members 12 years old and younger: Highway Crossroads Credit Union adheres to the Children’s Online Privacy Protection Rule (COPPA) that prohibits the collection of any personal information obtained online from a child under the age of 13. For members age 12 years old and younger, a parent or guardian must complete and submit the online redemption form for you OR you may stop by Highway Crossroads Credit Union office to claim your Great Grades Reward in person. Thank You!

Applicant Information
Name of Student Name of Student First Last
HCCU Account Number

Student Account Number
Name of Parent or Guardian Name of Parent or Guardian First Last
Best Contact Phone Number Best Contact Phone Number - ### - ### ####
Is the Student 13 Years of Age or Older?
Email Address
Number of A's or Equivalents
Report Card(s)
Attach Your Report Card(s)

Attach Files

(You can use pictures taken from your phone or scanned copies.)
Signature(s)
Student Signature

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Signature of Parent/Guardian (only necessary if student is not 13 years of age or older)

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.

Great Grades Redemption

Great Grades Redemption

Applicant Information

Report Card(s)

Signature(s)