Lavelle – Brother Kearney Scholarship Accepted Scholars’ Agreement The goal of the Lavelle – Brother Kearney Scholarship Program is to provide academic scholarships and career preparation for legally blind individuals to enter and advance in the profession of their choice. By accepting the Lavelle - Brother Kearney Scholarship, I accept the following terms and conditions:• I will read, complete, and sign the Lavelle-Brother Kearney Release/Waiver of Information Form (https://lavellefund.org/waiver-and-release/), authorizing the release of assessment, education, and employment data to the Lavelle Fund for the Blind.(Required) I Agree • I will renew my FAFSA form each year as close to January 1st as possible.(Required) I Agree • I will apply, and fulfill all eligibility requirements, for financial sponsorship from my state’s vocational rehabilitation agency. I will inform the Scholarship Program Coordinator of any changes to my state sponsorship.(Required) I Agree • I will maintain the highest level of personal conduct, academic integrity, and professionalism, in-person and online.(Required) I Agree • If placed on academic probation, I will notify the Lavelle Fund's Scholarship Program Coordinator as soon as possible. I will have one additional semester covered by the Scholarship in which to improve my grades and have the probation removed, otherwise the Scholarship is discontinued.(Required) I Agree • If my G.P.A. falls below 2.5, I will inform the Lavelle Fund's Scholarship Program Coordinator. I will submit a Plan of Remediation to the Scholarship Program Coordinator as soon as possible. This plan must be approved in order for funding to be continued for the next semester. Failure to adhere to this Plan may result in loss of funding.(Required) I Agree • If I am terminated or withdraw from school, I will be discontinued from the Scholarship Program, unless the withdrawal is temporary or arranged with the Scholarship Program Coordinator in advance.(Required) I Agree • If I transfer to a non-Lavelle affiliated school, I will be discontinued from the Scholarship Program.(Required) I Agree • My scholarship amount is calculated using data provided by the academic institution. If I am financially ineligible based on this calculation, I will not receive funding for the semester(s) in which I am ineligible. Failure to provide required information to the Financial Aid Office or the Commission for the Blind in a timely manner may result in charges necessitating student loans.(Required) I Agree • I will demonstrate satisfactaory academic progress. To ensure this, I will meet with my academic advisor every term to ensure that I am “on track” to graduate. I understnd that I am expected to graduate a four year degree program in no more than 8 semesters (i.e., no more than 6 semesters for a Law degree). Extending my Expected Date of Graduation will likely result in charges for which I am responsible (and may require student loans). The Scholarship Program Coordinator should be informed if/when the student requires additional semesters.(Required) I Agree • Expected Month of Graduation(Required)Select monthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember• Expected Year of Graduation(Required)Academic Major/Program• I will immediately notify the Scholarship Program Coordinator regarding any change to my name, address, email, or telephone number, if I drop classes, have any problems with academic accommodations, change my major, take fewer than 12 credits in a semester, request a leave of any kind, change housing plan, require an additional semester, consider withdrawing from school, or any other factors affecting my participation in school.(Required) I Agree • I will respond to email and telephone messages related to the Lavelle-Brother Kearney Scholarship in a timely manner.(Required) I Agree • I will engage in career development activities including mentoring, career readiness training, networking opportunities, internships, and summer work experiences. VISIONS Services for the Blind is available for these services. If I choose to work with an alternate service provider I will submit a verifiable log of such activities to Kate Morris.(Required) I Agree I will inform the Scholarship Program Coordinator about fieldwork or internship experiences required by my program 1 year in advance.(Required) I Agree • I will make use of my school’s campus support services including disability/accessibility support services, tutoring, and health/counseling/writing/technology centers, as needed.(Required) I Agree • I understand that fees for special programs, summer programs, off-campus housing, and travel-abroad programs above the regular cost of tuition and room and board are not eligible for Lavelle Fund support.(Required) I Agree • I understand that the Lavelle Fund reserves the right to modify or terminate scholarships at any time for any reason in its sole discretion, with or without notice.(Required) I Agree • I understand that providing fraudulent, inaccurate, or misleading information will result in the immediate terminatation of this Scholarship.(Required) I Agree • I understand that failure to abide by these terms may result in the termination of the Lavelle-BrotherKearney Scholarship.(Required) I Agree • The Lavelle Fund reserves the right to update/amend the terms of this agreement each year.(Required) I Agree Student Name(Required) First Last Student - select signature format(Required) sign using mouse or stylus sign using keyboard entry Student Signature - By signing below, I authorize the use of this electronic signature.Student Signature - By entering my name in the text field below, I authorize the use of this electronic signature.Is the student under 18 years of age?(Required) Yes No Legal Guardian - select signature format: sign using mouse/stylus sign via keyboard entry Legal Guardian Signature (if student is under 18)- By signing below, I authorize the use of this elelectronic signature.Legal Guardian Signature (if student is under 18) - By entering my name in the text field below, I authorize the use of this electronic signature.Student's School Email Address - A copy of this form will be sent to you automatically.(Required) Enter Email Confirm Email Phone(Required)Date(Required) MM DD YYYY NameThis field is for validation purposes and should be left unchanged. 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