High School Scholarship Registration

Thank you for participating in Vitalant’s High School Scholarship Program! Your school’s support saves lives. To streamline award processing, we are requesting your redemption information now. Please complete this form by May 31. Should your school qualify for an award, this information will be used to process the award. Final program results will be calculated in July. Award notifications will be sent by email. If you have any questions, please contact your Vitalant representative or review program guidelines at vitalant.org/highschoolscholarship.

Submitter Information

Current School Name *

First Name *

Last Name *

Award Redemption Information

Group, School or Scholarship Fund* to Make Award Payable** *

Mailing Address 1 *

Mailing Address 2

City *

State *

Postal/ZIP Code *

*Awards paid in this program are designated for the sole purpose of awarding scholarships. Any other use is not permitted.

**If earned, awards in this program will not be paid to any individual person, student or school representative. An individual’s name should not be entered in this field.