K:\Foundation\Scholarships\SCHSPONSORFORM.DOC (Revised 10/11)
Thank you for your support! Please complete the following information to identify your preferences and
priorities in selecting award recipients. Return the completed form to the WNCC Foundation Office, 1601
East 27
Street, Scottsbluff, NE 69361; (308) 630-6550. Please note that the more restrictions or
requirements scholarships have, the more difficult it is to award funds.
Official Title of Scholarship (for promotion and publication)
Name Phone
Address City/State/Zip
Fax number E-mail
Contact Person (Please notify us if any contact information changes.)
Name Phone
Address City/State/Zip
Fax number E-mail
Funding (check all that apply)
Award amount $
Check enclosed.
Donor will send check to WNCC by (date).
Donor requests WNCC bill the donor/contact person
annually or
by semester/term.
Scholarship is endowed with the WNCC Foundation. Annual award will vary based on
investment growth.
Administration of the scholarship should be as follows: (check all that apply)
WNCC will choose recipient and send name to donor.
WNCC will choose recipient and have recipient contact donor at number above.
Donor will select recipient, notify WNCC and send a check to: recipient college.
(continued on back)
K:\Foundation\Scholarships\SCHSPONSORFORM.DOC (Revised 10/11)
The recipient should have the qualifications listed below: (circle all that apply)
1. A resident of a particular state, county, area, etc.: Yes No
If yes, please specify:
2. A graduate of a particular high school(s): Yes No G.E.D. acceptable
If yes, please specify:
3. Majoring in a particular program of study: Yes No
If yes, please specify:
4. Have a minimum grade point average or higher on previous academic work: Yes No
If yes, 2.0 (C) 2.5 3.0 (B) 3.5 4.0 (A) no preference
5. Enroll at least: full-time (12+) ¾ time (9-11) ½ time (6-8) no preference
6. Be a: freshman (0-29 credit hrs completed) sophomore (30+ credit hrs completed) no preference
7. Demonstrate financial need: Yes No no preference
8. Attend a particular campus: Alliance Scottsbluff Sidney any
Use of funds: tuition fees books no preference
Unless otherwise specified, WNCC will permit funds to be used for any education-related expenses.
Limitations, if any, placed on the use of funds: If yes, please specify:
Is the scholarship renewable? Yes No
If Yes: Student must reapply each year
Automatically renew scholarship up to ____ semesters if student continues to meet
Please list any other issues, criteria or important information about this scholarship:
Sponsor signature: Date:
WNCC Foundation Office • 1601 E. 27
Street • Scottsbluff, NE 69361
(308) 630-6550 • fax (308) 630-6552
Financial Aid Office use only
No corrections needed
Please correct as indicated
Financial Aid initial Date
click to sign
click to edit