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We ask that all graduating seniors that participated in Cross Country and intend to further their education be considered for this scholarship by the Cross Country Coach and the Athletic Director. To be considered, this nomination form must be completed in full by the Cross Country Coach. Please type or print in ink. Each nominee will receive a $500.00 scholarship with one male and female from the greater Wausau area being named as the Wausau area’s outstanding high school senior Cross Country runner. Those individuals will receive a $2,000.00 scholarship.

The cross country coach and the nominee are asked to answer the following questions (outlined by number) on separate sheets of paper to be submitted with this nomination form. The answers should demonstrate that the student is a positive role model, displaying the characteristics of perseverance, dedication, determination, motivation, and leadership. These are the criteria for selection of the Outstanding Cross Country Runner of the Greater Wausau Area.

1. What has nominee achieved in Cross Country that is outstanding?
2. What recognition for achievement has nominee received from peers or coaches?
3. How has the nominee been a positive role model, displaying the characteristics of perseverance, dedication,
determination, motivation, and leadership?
4. Provide a list of activities they have participated in, either in school or outside of school (and the years involved),
including any extra-curricular activities, community programs, or work experience during this past year. Offices or
positions held, as well as any honors received should be indicated.

All awards and recognition will be presented at the Forrest’s Run Awards Ceremony scheduled for June 18th, 2016.
We strongly encourage all recipients to be present at the awards ceremony.

Your signatures below indicate that all information submitted is true to the best of your knowledge.

_______________________________________________ ________________________________________________
Signature of Cross Country Coach                                      Signature of Athletic Director
Date: ______________________________________         Date: ______________________________________

Name of Student Nominee: _____________________________________________________________

Student’s Home Address: _____________________________________________________________


Home E-Mail Address: _______________________________ Phone: ( ) ___________________

Parents or Guardians: _____________________________________________________________

High School Attending: _______________________________ Graduation Date: ______________

Qualified Post Secondary School student plans to attend next fall: _________________________________
Has he/she been accepted for enrollment: Yes No

Anticipated field of study and career goals: ____________________________________________________

Forrest Goetsch Charities a 501(C)(3) reserves the right to request additional information or documentation from the nominee if necessary.
Please mail all documentation by April 6th to:
Forrest Goetsch Cross Country Scholarship
R11581 Sportsmans Lane, Schofield, WI 54476
A Board Member of Forrest Goetsch Charities will contact the recipients before the ceremony.