EWVCF Scholarship Acceptance Form Δ Student InformationStudent Name:(Required) First Middle Last Permanent Mailing Address:(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code County:(Required) Berkeley Jefferson Morgan Hampshire Hardy Telephone:(Required)Email Address:(Required) This will be our primary way of contacting you. Please provide an address for an email account you can access after you graduate from high school - Do not use your @stu.k12.wv.us address.Name of Scholarship(s):(Required)Please list each scholarship award you received from EWVCF.Amount:(Required)Please list the amount of each scholarship award.Please select if you will ACCEPT, DECLINE or DEFER this scholarship from the Eastern West Virginia Community Foundation:(Required) ACCEPT DECLINE DEFER By accepting one or more scholarships from the Eastern West Virginia Community Foundation, you agree to the following terms: I understand the award(s) will not be paid if I do not meet the requirements or stated criteria of the scholarship(s). I am not directly related to any of the employees or board members of the Foundation, its scholarship committee, or the scholarship committee overseeing the awarded scholarship(s). I understand this scholarship(s) will be applied toward the cost of attendance at the above institution and that some costs are non-exempt, which could create a taxable event. I authorize EWVCF to release information regarding my scholarship(s) to my school and to the public through media and publications from the Foundation.If you are planning to defer your scholarship for part or all of the 2025-26 school year, please contact Karin Harman Dunn at 304-671-8167 or [email protected].College/University Name:(Required)COLLEGE/UNIVERSITY Mailing Address:(Required)Please verify you are providing the correct address for mailing scholarship award payments. Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Major:(Required)Student ID#:(Required)We cannot process your scholarship payment without your Student ID#. Checks are made payable to the college or university you plan to attend and will be mailed to the college or university by the end of June. Please contact the financial aid department at your school with questions or concerns regarding the way your scholarship award is applied to your student account. We are prohibited from paying scholarship awards directly to students or to for-profit institutions.Please include a picture (jpeg) of yourself:(Required) Drop files here or Select files Max. file size: 2 MB, Max. files: 1. Please include a donor thank you note:(Required) Drop files here or Select files Max. file size: 100 MB. If you received more than one scholarship, please include a note specific to each scholarship.Would you like to receive news and updates from EWVCF?(Required) Yes No Would you like to be considered, as a future volunteer, for our scholarship program in any of the following capacities?(Required) Reception Speaker Selection Committee Scholarship Alumni Group Not interested at this time Many donors like to connect with the students who benefit from their scholarship. If you would prefer that we NOT share your contact information with the donor of your scholarship, please check here: DO NOT share my contact information with the scholarship donor. By submitting this form, I acknowledge and agree to the following:(Required) I ACCEPT this scholarship from the Eastern West Virginia Community Foundation (EWVCF). I currently meet the criteria in the scholarship description for the scholarship I am accepting. I am not directly related to any of the employees or directors of the EWVCF. I authorize EWVCF to release information regarding my scholarship to my school and the media and publish my picture in its publications. I understand that this award is only to be used for tuition and educational expenses. Any unused portion of this award will be returned to EWVCF. It is my responsibility to ensure that EWVCF is notified of any changes such as school transfer, change of contact information or discontinuation of education.By submitting this form, I acknowledge and agree to the following:(Required) I DO NOT ACCEPT this scholarship from the Eastern West Virginia Community Foundation (EWVCF).*An alternate recipient will be chosen.This field is hidden when viewing the formWould you be willing to meet with your Scholarship Donor(s)?(Required) Yes No (Question is hidden from applicants. We have to leave this field here so that previous student answers do not get deleted.)