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Please note:
  • You must complete this form, including sending your digital senior photo, before your check can be mailed.
  • The check will be payable to both you and the school you will attend.
  • Indicate the date you wish to receive the check. Please allow time for you to receive it, endorse it, and send it on to the school before payment due date.
FIRST NAME:
LAST NAME:
ADDRESS: (Check will be mailed to this address)
CITY:
STATE:
ZIP:
TELEPHONE NUMBER:
EMAIL: (please provide your personal email address, not one from your high school.)
NAME OF COLLEGE/UNIVERSITY ATTENDING:
DATE YOU WOULD LIKE TO RECEIVE CHECK (MM/DD/YYYY FORMAT):
/ /
SCHOLARSHIP(S) AWARDED:
DIGITAL SENIOR PHOTO:
Permitted formats are jpg, png or gif, no larger than 10MB.
Select image to upload:
It will take a few moments to upload your image file. Please do not press SUBMIT more than once.
 
The Union County Foundation
David A. Vollrath, Executive Director
126 N. Main Street | P.O. Box 608, Marysville, Ohio 43040 | 937.642.9618 | info@UnionCountyFoundation.org
Hours: Monday - Friday, 9:00 a.m. to 4:30 p.m.
Council on Foundations National Standards
 
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