Scholarship Funds Release Form

This is for past scholarship recipients who have been accepted to a college or university

Congratulations on your award. We are happy to help with your education and career goals. When you have been accepted into the school you will be attending and have a complete high school transcript, note that scholarship funds will not be released until a transcript of your 10^th, 11^th, and 12^th grades have been received to verify that you met the 3.5 GPA requirement. Please wait until you graduate and send one complete transcript.

Please submit the information in the form below and send transcripts to the Foundation.  

To make you are aware of the process, once the required paperwork is submitted from a student, a Grant Agreement is sent to the appropriate University.  The agreement is between the school and the EnergySolutions Foundation which states that the University will distribute the money according to our guidelines.  Once the agreement is returned, the money is released to the university. Please allow at least six weeks for processing.

Mail your transcript to:
EnergySolutions Foundation
PO Box 510583
Salt Lake City, Utah 84151

Student Information

1. First Name
2. Last Name
3. Date of Birth
4. High School Attended
5. State Georgia Idaho Illinois New Mexico Ohio South Carolina Tennessee Utah Washington Canada
6. Year You Received Scholarship
7. Student's e-mail address(valid email required)

University / College Information Financial Aid Information

1. University / College Name
2. Address (Financial Aid Office)
3. City
4. State
5. ZIP
6. Phone Number
7. Major Declared Biochemistry Biology Chemistry Ecology Engineering Environmental Sciences Geology Geophysics Mathematics Meteorology Physics
8. Per the application you submitted, if the major you want to declare in college is not on this list, you are not eligible for the scholarship.
9. College / University Deadline (Date your scholarship must be in your account)

Acknowledgement

1. By checking this box, I acknowledge that I am at least 18 years of age and do hereby grant permission to the EnergySolutions Foundation to use and distribute my name, photograph, likeness, and/or voice in any way that would reasonably portray, publicize and promote the EnergySolutions Foundation Scholarship Program, including, without limitation, colleges, universities, brochures, magazines and other printed materials, audio and video taped productions, and broadcast on television, radio and websites, such as Facebook and Flickr. I have read this permission and agree to release EnergySolutions Foundation, and any of its employees or agents, from any damages whatsoever, associated with using my name, photograph, likeness, and/or voice.
2. Agree