Departing Student Scholarship Application

Please note: Incomplete scholarship applications or applications received after the deadline will not be considered for UW Fox Valley scholarhips.

• Complete this application if you are currently enrolled student at UW-Fox Valley and plan to transfer for fall 2012. Generally, Departing Scholarships are awarded to students who have eraned 60 or more credits.
• All scholarships are for the 2012 - 2013 academic year, with half of the amount awarded for each semester and policies at your transfer school
• Generally, departing scholarships are provided by transfer universities.
• By submitting this scholarshiph application you are giving permission for your application, academic records, and FAFSA information to be reviewed by the UW-Fox Valley Scholarship Committee, Dean, and donors involved in the selection process. All financial and academic record information is, and shall remain, confidential.
• Scholarship decisions will be made by April 15, 2012, and you will be notified by mail.

Personal Information

First Name Last Name

Phone: ex. (xxx) xxx-xxxx

Address City

State Zip

Email (Required)

Student ID or SS#

Birthdate (mm/dd/yyyy)

• High School Graduation Year: (mm/yyyy)
• Do you intend to be a full-time student, taking 12 credits or more? Yes No
• If you marked "No," how many credits do you plan to take?
• Anticipated major(s)?
• Intended Transfer Campus for Fall 2012 enrollment
  UW Green Bay
  UW Madison
  UW Oshkosh
  UW Platteville Engineering Program
  Other, please specify
• Date applied or will appy to transfer campus? (mm/yyyy)
• From your transcript, list your cumulative grade point average after Fall 2011 and list your number of cumalitve credits
  GPA:
  Cumulative Credits:

I certify that the information supplied is complete and accurate to the best of my knowledge. I understand that knowingly submitting false information will result in the loss of any scholarship offers or awards.

I am aware that the composition of the committee consists of faculty, academic staff, and one student. I understand a copy of my entire scholarship application will be made available to each committee member.