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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.
  • To prevent spam, you will be required to enter a Scholarship Code on this form. You will find that code in your Scholarship Recipient Instructions letter.
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:
ENTER THE SCHOLARSHIP RECIPIENT CODE (FOUND IN YOUR LETTER FROM UCF):
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
Adam J. Hodnichak, 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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