Branch County Community Foundation 2024 Scholarship Acceptance Form

Branch County Community Foundation 2024 Scholarship Acceptance Form
If you choose to accept your scholarship, please submit this form within 90 days of receipt (by August 1, 2024), or it will be awarded to an alternate applicant. If a time extension is necessary, please submit a written request to the Foundation office before the 90-day period (August 1, 2024) has expired giving the reason for delaying the scholarship payment and a time line for when funds will be needed.

So that we can accurately process your award, please fill in all the information requested. If you do not provide an identifying number, your scholarship check may not be credited correctly by the college. If you have questions, please contact us at 517.278.4517 or info@BrCoFoundation.org.
Recipient Information
Name:*

First NameLast Name
Email:*
Please enter a personal email address, not a school email address.
Phone Number:*
Please enter a valid phone number.
Mailing Address:*

Street Address

Street Address Line 2

CityState

Zip Code
Are you a US Citizen or Permanent Resident Alien?*

YesNo
Proof of FAFSA

All BCCF Scholarship applicants must fill out a FAFSA. For proof of FAFSA, you can upload your Student Aid Report (SAR) or submission summary. For information on how to locate the submission summary, please visit https://studentaid.gov/apply-for-aid/fafsa/review-and-correct/sar-student-aid-report
FAFSA *

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Scholarship Information
Name of Scholarship:*
Scholarship Amount:*
(Found in Award Packet)
Name of second Scholarship:
(Required if you received two scholarships)
Scholarship Amount:
(Found in Award Packet)
Name of third Scholarship:
(Required if you received three scholarships)
Scholarship Amount:
(Found in Award Packet)
Name of fourth Scholarship:
(Required if you received four scholarships)
Scholarship Amount:
(Found in Award Packet)
College Information

Provide the mailing address for the specific office or department for scholarship and/or financial aid payments. That office may have a different address than the college administrative offices. Providing incorrect or incomplete information may delay your award being credited to your account.
Name of College/University:*
Student ID #:*
College/University Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Degree Type & Program

Please identify the type of degree you will receive upon completion of course work in which you are enrolled (e.g. Bachelor of Arts). Please identify the degree program in which you are enrolled (e.g. public administration). Please include a copy of your acceptance letter with proof of degree program below.
Degree Type & Program:*
College/University Acceptance Letter*

If you have an acceptance letter that lists your declared Major, please submit that letter here!
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Authorization to Release Information

If you are 18 years of age or older, we may only discuss scholarship information and issues with the applicant and the applicant’s college.
I authorize the Branch County Community Foundation to discuss my scholarship information with the person named below.
Authorized Person's Name:

First NameLast Name
Relationship to Applicant:
Authoriized Person's Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.
OR

I DO NOT authorize the Branch County Community Foundation to release information about my scholarship to anyone but me and the college/university I am attending.
Applicant's Signature:*

Clear
Date*

MonthDayYear
Date

Required Documents for Scholarship Acceptance
Your scholarship was made possible because of the generosity of someone in our community. Please write a thank you note to that donor and upload it here:*

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Terms of Scholarship

All funds will be paid directly to the educational institution. The scholarship must be split equally into fall and spring semester. Any refunds due will be paid directly to the Branch County Community Foundation.
Scholarship acceptance agreement:
Please consider my signature on this scholarship acceptance form as official acceptance of the scholarship offered to me under the terms noted below. My signature also indicates that I understand and agree to comply with the criteria listed below:
1. I understand that I have tentatively been awarded a scholarship through the Branch County Community Foundation. I understand that if my scholarship becomes final, I will receive a confirmation letter from the Foundation. I also understand that if there are issues with my scholarship I will be contacted by a staff member from the Community Foundation.
2. If this scholarship is for full time students only, as defined by the program in which I am enrolled each semester, I understand that failure to maintain at least full time status in a semester may result in the cancellation of my scholarship.
3. The award amount is distributed half in the fall and half in the spring semester, unless otherwise indicated.
4. As a recipient of a Branch County Community Foundation Scholarship, I agree to write and sign a thank you letter to the donor and submit it to the Community Foundation.
5. I understand that both this signed Scholarship acceptance form and a thank you letter to the donor must be received by the Branch County Community Foundation by August 1, 2024, or payment of the award will not be released and paid to the college and an alternate recipient may be selected.
6. The award may be used at an eligible educational institution for tuition and fees required for enrollment or attendance at the educational institution and course-related expenses such as books, supplies, and equipment required for courses of instruction. Funds may not be used for room and board, travel, research, clerical help, and non-required equipment, because these are not qualified educational expenses IRS regulations and therefore represent taxable income to you.
7. It is also understood that appropriate publicity of scholarship recipients in the form of announcements to the news media and internal and external publications may be made by the Branch County Community Foundation.
Signature

I agree to the terms and conditions of the scholarship. I understand that failure to adhere to these requirements may result in the termination of this scholarship.
Signature*

Clear
Date*

MonthDayYear
Date

Celebrating Your Accomplishments
The Branch County Community Foundation is excited to celebrate you and your accomplishments! Please provide the Community Foundation a photo and short biography that will be posted on our social media and website. Attached is a list of helpful hints when you’re writing your biography.
Type your short biography here:*

(Minimum of 75 words)0/0500
Upload your photo here:*

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Should be Empty:

Branch County Community Foundation 2024 Scholarship Acceptance Form

Recipient Information

Proof of FAFSA

Scholarship Information

College Information

Degree Type & Program

Authorization to Release Information

Required Documents for Scholarship Acceptance

Terms of Scholarship

Signature

Celebrating Your Accomplishments