Impact Statements and Reimbursement Form

Program scholarships are awarded as reimbursements. The scholarship recipient must use awarded funds for the sole purpose(s) stated on the application. Scholarships are nontransferable. To receive a scholarship reimbursement, the recipient must submit a complete Foundation Impact Statement and Reimbursement Form, with invoices and receipts, to the Foundation within 60 days of the course / event’s conclusion date. Failure to comply with this deadline may result in automatic and total scholarship forfeiture. Please note that only itemized receipts will be reimbursed. Non-itemized receipts will not be reimbursed.

Name
First Last
Email
Impact Statements
Impact Statement A: Recap*
Please share about event/course you participated in. What goals and objectives were met through your learning? What were the benefits of your engagement?
Impact Statement B: Next Steps*
What will you do to ensure what you’ve learned will be implemented into your professional practice and credit union?
Impact Statement C: Insights*
What has this scholarship meant to you? To your credit union? How do opportunities like this impact the Credit Union Movement?
Please feel free to leave a message to our GoWest Foundation donors that help make these scholarships possible.
Permission
- You have my consent to use the information provided in the Reimbursement and Impact Statement to spread awareness of the GoWest Foundation Scholarship Program.
Upload Receipts and Invoices
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Max. file size: 256 MB.
Upload Pictures (Optional)
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Max. file size: 256 MB.