DeKalb County Community Foundation Scholarship Acceptance Form
Congratulations! You've received a scholarship from the DeKalb County Community Foundation. To accept your scholarship, complete this form in it's entirety and submit by July 16.
The DeKalb County Community Foundation distributes many scholarships each year. If you received multiple awards from our pool of scholarships you need only to complete this form once. List all your scholarships in the following field.
Scholarship(s) you were awarded *
Personal Information and Permanent Mailing Address
First Name *
Last Name *
Middle Name
Phone Number *
Can you receive texts at this phone number? *
Primary E-Mail Address *
Address Line 1 *
Address Line 2
City *
State *
ZIP Code *
Birth Date *
Upload a recent photo of yourself (if you do not have a google or gmail account, skip this response and email a photo to
College or University Information
Student Identification Number *
I will pursue secondary education at the following college or university in the Fall of 2018: *
If you selected "other" in the previous list of colleges and universities, what is address for your college or university's Office of Financial Aid and Scholarships?
Provide all mailing address information for your college or university's financial aid office in your answer above. Only students attending schools other than those listed need to complete this field. Your scholarship check will be mailed directly to this address.
What is your intended degree or area of study? *
Scholarship donors may be interested in knowing more about you and your future plans. Please share a short description of your education and/or career aspirations.
Photo Release and Signature
In the interest of promoting this scholarship and others held at the DeKalb County Community Foundation, we ask for permission to share your photo publicly.

The undersigned hereby consents to the legal use by the DeKalb County Community Foundation (and its designees) of any and all photographs and videos of me taken or provided, in whole or in part, in any form or medium, for news stories, social media, publicity, and website posting. I understand that the Community Foundation shall have reproduction rights to the content. The undersigned waives any right to inspect or approve the finished products. The undersigned hereby releases the DeKalb County Community Foundation from any and all claims in connection with the photograph(s) and or videos, including any and all claims of libel.

When you submit this form electronically, insertion of your name and date in the fields below constitutes a valid signature. Do you agree to sign this form electronically, consenting to the photo and video usage stated above? *
Recipient Signature (typed first & last name) *
Parent/Guardian Signature if recipient is under 18 at the time of signing (typed first & last name)
Date Signed *
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