College/University Scholarship Report

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La Crosse Area Community Foundation > College/University Scholarship Report

Colleges and Universities who received a scholarship grant to be disbursed to a student or students from a La Crosse Area Community Foundation scholarship fund must complete this form after the scholarship has been disbursed.

Questions? Call Megan at (608) 782-3223 ext. 26 or email megan@laxcommfoundation.com.

Organization Name:*
Scholarship Fund Name:*
Grant Amount:*
Grant Date:*
Grant Number:
Contact Person:*
Contact Email:*
Name of scholarship recipient(s), including amount awarded, declared major and school email address for each student:*
Date scholarship funds were disbursed to student account(s):*
Were all of the grant funds disbursed?*
- Yes
- No
I certify that the selection of the recipient was done in an open, fair and equitable process; that no member of any recipient's immediate family participated in the selection process; and that the criteria for the scholarship, as determined by the donor, was fully met.*
- Yes
- No
Signature:*

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