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La Crosse Community Foundation > Apply for Funding > Scholarship Recipient Form

Scholarship Recipient Form

Student recipients of a scholarship from a La Crosse Community Foundation scholarship fund must complete and submit this form to confirm a scholarship award and provide the information needed for payment purposes. This form is for new and renewing scholarships only.

Questions? Call Sherry at (608) 782-3223 ext. 21 or email sherry@laxcommfoundation.com.

First and Last Name:*
College Student ID#:*
Scholarship Received:*
Email:*

Please provide the email address you monitor most closely.
Phone Number:*
Current Address:*

Street, City, State, Zip Code
Optional - Parent/Trusted Adult Email:
High School Attended:*
College or University Attending:*
Upcoming Year in School:
- Freshman
- Sophomore
- Junior
- Senior
Address of College or University Attending (where to send payment):*
City:*
State:*
Zip Code:*
Your Major:*
Unofficial Transcript:*
Accepted file types: jpg, gif, bmp, doc, docx, pdf, Max. file size: 256 MB.
To find instructions on how to download your unofficial transcript go to your college or university's website, click the search feature, and type "unofficial transcript." We do not require "official" transcripts. Unofficial transcripts should be FREE.
Do you give permission to La Crosse Community Foundation to discuss your scholarship award with your parent(s) and/or other trusted adult?*
- Yes
- No
If yes, please list the names and contact information (phone and/or email).

We will only contact these individuals if we are unable to reach you directly.
Do you give permission to La Crosse Community Foundation to share your phone and email address with the scholarship donor (if they ask)?*
- Yes
- No
Do you give permission to La Crosse Community Foundation to publish your name and the name of your institution in our list of scholarship recipients?*
- Yes
- No
I understand that if I change my major or drop out of school or do anything that changes my status as a student at the above named school, college, or university in the major indicated, I will notify La Crosse Community Foundation immediately.*
- I understand.

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401 Main St., Ste. 205
La Crosse, WI 54601

(608) 782-3223

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