Deer River High School Health Career Scholarship; Follow-up
Complete this form after successful completion of your first semester (within one year of original award notification) for payment to be made directly to your educational institution.
Date of Request
*
-
Month
-
Day
Year
Date
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Current Degree Program
*
Do you intend to continue in this course work/program?
*
Yes
No
Unknown
If you answered "no" or "unknown", please explain:
Anticipated Completion Date:
*
-
Month
-
Day
Year
Date
Do you have an interest or intend to return to the Deer River area to work in your health career?
*
Yes
No
Unknown
What was your first semester GPA?
*
What is your college/university/educational institution name:
*
To what department shall we making the mailing 'attention to'?
*
What is the mailing address to where the payment should be sent?
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What is your Student ID?
*
Please upload a copy of your first semester transcript:
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Is there anything else you feel we should know or be aware of as it relates to payment of your scholarship and the information contained herein:
By signing below, you are confirming the integrity of your request and attesting to it's legitimacy.
*
Submit
Should be Empty: