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Departing Student Scholarship Application

Academic Year 2014-2015

Application Deadline: February 3, 2014

Complete this application if you are currently enrolled student at UW-Fox Valley and plan to transfer for fall 2014. Generally, Departing Scholarships are awarded to students who have earned 60 or more credits.

Personal Information

First Name Last Name

Phone: ex. (xxx) xxx-xxxx

Address City

State Zip

Email (Required)

Student ID or SS#

Birth date (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 2014 enrollment
    UW Green Bay
    UW Madison
    UW Oshkosh
    UW Platteville Collaborative Engineering
    Other, please specify
  • From your transcript, list your cumulative grade point average with your Fall 2013 grades and list your number of cumulative credits (This will be verified.)
    GPA:
    Cumulative Credits:

List your UWFox club/sport or any academic activity involvement.

Please provide a statement about your educational and career goals.   (300 characters max)


(Maximum characters: 300)
You have characters left.


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.

I am aware that I should only submit one application. Duplicated submissions will disqualify my application altogether.