Regional Relocation Group Scholarship Form

Regional Relocation Group Scholarship Form
Name of Regional Relocation Group*
Regional Relocation Group Contact Person*

First NameLast Name
Regional Relocation Group Contact Person Email Address*
example@example.com
Regional Relocation Group Contact Person Phone Number*
Please enter a valid phone number.
Student Applicant Information
Student Applicant Name*

First NameLast Name
Student Applicant College*
College Location*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Year Student Relocated*
Student relocated FROM*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
TO*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Regional Group Information

Please confirm the following that apply to your specific regional relocation group
Are you a Foundation Walk Sponsor?*

YesNo
Are you a recognized WERC® Regional Relocation Group?*

YesNo
Is this a part of your organization's Community Outreach program?*

YesNo
Is this a part of your organization's established scholarship program?*

YesNo
How many scholarship awards and in what amount does your Regional Relocation Group anticipate making this year?*
When do you plan to award your scholarship(s)?*
Student Applicant Requirements

Please confirm the following were received and reviewed by the regional group. Proof of requirements below DO NOT need to be sent to WERC® - just confirmation by the regional group per this check list.
School Change Requirement*

YesNo
Defined timeframe for relocation*

YesNo
Confirmation that student is good-standing*

YesNo
Confirmation of student's GPA is 2.5 or better on a 4.0 scale*

YesNo
List of extra-curricular activities were provided

YesNo
Please attach student’s essay/video by May 31st by 11:59PM PST. No applications will be accepted after May 31st.

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Upload Regional Relocation Group's W-9 Form

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Regional Relocation Group Scholarship Form

Student Applicant Information

Regional Group Information

Student Applicant Requirements