Scholarship Acceptance Form

Merrick Foundation is pleased to provide academic scholarships to area students pursuing post-secondary education. All scholarship recipients are required to complete the Scholarship Acceptance Form below in order to redeem your award. Please read all instructions carefully. Congratulations and best wishes with your future education!

2026 recipients must submit this form by Wednesday, July 15, 2026 in order to receive their scholarship payment. All payments will be sent directly to your school with instructions to divide your award equally among fall 2026 and spring 2027 terms. Please note that if you do not submit your form by July 15, payment to your college WILL be delayed. If you will be a fall 2026 graduate, please let us know so we can direct your college to NOT split your scholarship. Please call us at 308-946-3707 or email Rachel at rachel@merrickfoundation.org with any questions.

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Scholarship Recipient:

First Name *

Last Name *

Address:

Country

Address Line 1 *

Address Line 2

City *

State/Province *

Postal Code *

Email: (Required)

Cell Phone: (Required)

** Please upload a copy of your class schedule for the fall 2026 term OR verification of enrollment from your college. These are both documents proving that you are enrolled in fall semester classes. Ensure your name appears on the uploaded document, and if possible your student ID as well. If your schedule indicates you are enrolled less than full time we may be in contact with you for additional information. **

Fall 2026 Class Schedule or Verification of Enrollment: (Required)

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School/University Name: (Required)

School Mailing Address:

This is the address where your scholarship check will be sent. Each school is different, so please check with your Financial Aid/Bursar's Office regarding where scholarships are to be directed.

Country

Address Line 1 *

Address Line 2

City *

State/Province *

Postal Code *

Student Identification Number: (Required)

Do you have plans to transfer colleges mid-semester or graduate mid-semester? If you answer yes, please describe your plans in the box below. We may contact you for additional information.

Please explain your answer 'Yes' to the above question.

** Please upload a copy of the thank you letter that you have sent or will be sending to your donor. Your donor's contact information was included in the packet provided to you at the Scholarship Awards or mailed in late April if you could not attend the ceremony. If you received multiple scholarships, you may be required to write more than one thank you as directed in your packet. **

NOTE: Show the actual message written, NOT just the outside of the envelope.

Donor Thank You(s): (Required)

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Please describe how this scholarship has impacted you:

Please know this information may be posted on our website, social media, or print publications.

In certain situations, scholarship funds may be considered taxable income for the recipient. The Internal Revenue Service provides information about scholarships on their website at: http://www.irs.gov/taxtopics/tc421.html. For questions about how your scholarship(s) may impact you directly, please consult with your tax professional.

Submitting this form means you agree to the terms and conditions of the scholarship. Following a successful submission, you will be taken to a confirmation screen as well as receive a confirmation email. If these two things do not occur, please contact our office to be sure we received your form.

Scholarship Acceptance Form

Scholarship Acceptance Form

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