Recommendation Form

For Merrick Foundation Applications due February 1, 2017.

Please use the "tab" key to move from field to field. Once completed, please
print and mail to: Merrick Foundation, 1532 17th Ave, Suite B, Central City, NE 68826.

Name of Applicant:
Name of Scholarship:
Name of person giving recommendation:
State how you have been associated with applicant:

Statement about character and achievements of applicant (Please use he/she and not applicant's name):



Please print out this form and sign and date below. 

Mail completed form to:
Merrick Foundation, Inc.
1532 17th Ave, Suite B, Central City, NE 68826

 
____________________________________________              ______________
Signature                                                    ......................... Date



Please print out two copies of this form. One to sign and mail in, and the
other to retain for your records. For your security, please hit the "Clear" button
when finished and return to the application by using the "back" button in your browser.

Contact Information:

Merrick Foundation, Inc.
1532 17th Ave, Suite B, Central City, NE 68826
Phone: 308.946.3707 Fax: 308.946.3049
General Information: merrickf@hamilton.net