CFDC Scholarship Acceptance Form - Community Foundation of Dunn County

Scholarship Acceptance Form

All Community Foundation of Dunn County scholarship recipients must complete the following form and upload the required documentation by January 31st in order to receive scholarship payments. You must first complete your fall semester of college and successfully enroll in the spring semester in order to complete this form. All CFDC scholarship awards are applied to second semester tuition expenses. Call (715) 231-0344 with questions or email grants@cfdunncounty.org.

"*" indicates required fields

Date*

Name*

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Permanent E-mail Address:*

Cell Phone*

The name of the scholarship(s) you are accepting:

College Transcript (File Size Limit 50MB)

Please upload an electronic copy of either your official or unofficial transcript showing successful completion of the Fall Term. You can request an official PDF version of your certified transcript from your school and upload the file here. If you have problems, you can mail a hard copy to the Community Foundation of Dunn County at PO Box 498 Menomonie, WI 54751.

Accepted file types: jpg, jpeg, gif, png, pdf, Max. file size: 512 MB.

or Direct Mail

I am mailing my transcript to the Community Foundation.

Please upload a copy of your class schedule for the Spring Term.

This is a document proving that you are enrolled in the Spring semester. If your Spring Semester courses are already listed on the official transcript you uploaded, you can skip this step. If they are not, please upload a copy of your spring class schedule and you MUST ensure your name or student ID appears on the document which you upload.

Accepted file types: jpg, jpeg, png, gif.

Name of your University/School:*

School mailing address to receive your scholarship payment:*

Please provide the mailing address where your scholarship check should be sent. Each school is different so please check with your Financial Aid office/Bursar's office regarding where scholarships are to be directed.

Building/Department Street Address City State / Province / Region ZIP / Postal Code

Your Student Identification Number:*

Please describe how this scholarship has impacted you. (Please know this information may be posted on our website or print publications):

If you haven't already, please upload a senior photo or another recent photo of yourself for our website (or other publications):

Accepted file types: jpg, jpeg, png, gif.

Photo Release Consent

I hereby grant permission and give my consent to the Community Foundation of Dunn County for the use of the enclosed photograph(s) or electronic media images to be used in publications and materials without restriction. I hereby irrevocably authorize the Community Foundation of Dunn County to edit, alter, copy, exhibit, publish, or distribute this photo for any lawful purpose. In addition, I waive any right to inspect or approve the finished product wherein my likeness appears.

Once your scholarship acceptance and documentation is approved, your scholarship check will be made out directly to your school and mailed to the address you provided. Call the Community Foundation at (715) 231-0344 if you have issues completing this form.

Phone

This field is for validation purposes and should be left unchanged.

Scholarship Acceptance Form

IF YOU RECEIVE AN ERROR MESSAGE WHEN SUBMITTING THIS FORM, YOU CAN SEND YOUR NAME AND ATTACHMENT FILES VIA EMAIL TO grants@cfdunncounty.org.