Scholarship Distribution Form

Scholarship Distribution Form

This form must be submitted to the community foundation by December 31st
Congratulations on being awarded a scholarship through the Midland, Clare or Gladwin community foundation!

In order to arrange payment of the scholarship, please fill in the information below. Once received, we can issue a check to your school. A copy of the transmittal letter will be sent to you at the address you provide below.
Name of Scholarship*
Additional Scholarship
Additional Scholarship
Additional Scholarship
Additional Scholarship
Your Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Email*
example@example.com
Mobile Number
College/University Student ID*
College or University*
College or University Address*
Tuition Due Date*
In a couple sentences tell us what receiving this scholarship means to you?
Do we have permission to use your quote in Midland Area Community Foundation communications?

YesNo
By clicking "send" below, I authorize and request the community foundation to mail or otherwise transmit to the college or university identified above my student ID number and my social security number if it is used as my student ID number.
Should be Empty: