Western Carolina University____________________________

Office of Financial Aid	Phone: (828) 227-7290

Scholarship Coordinator	Fax: (828)227-7042

118 Killian Annex	Web: www.wcu.edu/finaid

Cullowhee, NC 28723	Email: finaid@wcu.edu

OUTSIDE SCHOLARSHIP DONOR FORM

Please fill in organization/donor information in the blocks below.

Organization/Donor: Contact Person: Address:	City:

State:	Zip code:

Email:	Phone:

Enclosed please find check(s) in the amount of $ for payment of the

Scholarship for the Academic year for the following student(s):

Student ID or SSN	Student Name	Total Payment	Divide Fall/Spring	Fall Only	Spring Only	Summer	Student Discretion

If additional space is needed, please attach an additional page.

*If applied to fall only, is this the first of multiple payments for this academic year? YES NO

*If the student(s) has registered less than full-time (12 credit hours for undergraduate or 9 credit hours for graduate), may the student receive this scholarship? YES NO

Please make checks payable to Western Carolina University. Send Payments to the following address:

Western Carolina University

Office of Financial Aid

118 Killian Annex

Cullowhee, NC 28723

Help us to process your scholarship payment accurately and promptly; make sure to answer all questions.

If you need assistance, please call the Scholarship Coordinator at (828) 227-7290

VB-18 Nov 09