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, authorizing the release of assessment, education, and employment data to the Lavelle Fund for the Blind.(Required) I Agree I Do Not Agree • I will renew my FAFSA form each year as close to January 1st as possible.(Required) I Agree I Do Not Agree • I will apply, and fulfill all eligibility requirements, for financial sponsorship from my state’s vocational rehabilitation agency.(Required) I Agree I Do Not Agree • I will maintain the highest level of personal conduct, academic integrity, and professionalism, in-person and online.(Required) I Agree I Do Not Agree • If placed on academic probation, 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 I Do Not Agree • If my G.P.A. falls below 2.5, I will submit a Plan of Remediation to the Scholarship Program Coordinator. This plan must be approved in order for funding to be continued for the next semester.(Required) I Agree I Do Not 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 I Do Not Agree • If I transfer to a non-Lavelle affiliated school, I will be discontinued from the Scholarship Program.(Required) I Agree I Do Not 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 Do Not Agree • I will demonstrate satisfactory academic progress. To ensure this, I will meet with my academic advisor on campus every term to ensure that I am “on track” to graduate.(Required) I Agree I Do Not Agree • I will immediately notify the Scholarship Program Coordinator regarding any change to my name, address, email, or telephone number, if I drop classes or change my major, consider withdrawing from school, or any other factors impeding academic progress.(Required) I Agree I Do Not Agree • I will respond to email and telephone messages related to the Lavelle-Brother Kearney Scholarship in a timely manner.(Required) I Agree I Do Not Agree • I will engage in career development activities including mentoring, job readiness training, networking opportunities, internships, and summer work experiences.(Required) I Agree I Do Not 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 Do Not 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 Do Not Agree • The Lavelle Fund reserves the right to update/amend the terms of this agreement each academic year.(Required) I Agree I Do Not 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 Date(Required) MM DD YYYY PhoneThis field is for validation purposes and should be left unchanged. Δ