Fund Distribution Request : Portal : Oregon Trail Community Foundation

Fund Distribution Request

Name of Fund

Fund Contact Person

First Name *

Last Name *

Contact Person Phone number

Email address

Name of high school

Last 4 digits of Social Security #, or College ID #:

Date of Birth

Month

Day

Year

Mother's phone number

Mother's email address

Father's Name

First Name

Last Name

Class Rank

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# of Students in Class

ACT score

College, university or technical school you plan to attend

Anticipated year of college graduation

School activities, including organizations, athletics, music, student government, etc.

Community-related activities including clubs, church groups, volunteer work, etc.

Work experience

Additional information you'd like us to know about you!

Have you been awarded the following scholarships?

Regents Scholarship
Other Full-Tuition Scholarship

Please list scholarships you've applied for, and indicate with an asterick * any you have been awarded and the amount of award

List your 3 references her, including thier name, your relationship and their phone number

No more than 2 letters may be from high school personnel

Please submit your ACT Scores Here

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Submit your 3 letters of reference here:

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Please submit your personal essay*

*if required by scholarship

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Please submit any other information pertinent to this scholarship you'd like to share

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This scholarship is awarded to graduates planning to attend Western Nebraska Community College.
Please upload WNCC admission confirmation

Date of Request

Fund Distribution Request

Fund Distribution Request

Our Impact - 2023