Confidential Student Outcome Report


Confidential Student Outcome Report Form for Colleges Participating in the Brother James Kearney Scholarship for the Blind

  • Enter the date for when you are submitting this report.
  • Thank you for your promise, as a condition of receiving Lavelle-Brother Kearney Scholarship support, to provide your college (normally, the Disability Services Office) with the education and employment outcome data specified below at three times: (1) when you graduate (or withdraw) from the college, (2) one year after such graduation, and (3) at any other time, within five years of my graduation, at which your college may decide to seek such data through alumni surveys. By signing your student release form, you have authorized your college to convey this information to the Lavelle Fund’s board and staff, who will not share it with anyone outside the Fund.

    Please Report on the Following Outcomes:

  • Reported Only at the Time of Graduation
  • Reported Only at the Time of Graduation
  • Including field of study, if not self-evident.
  • MM slash DD slash YYYY
  • This field is for validation purposes and should be left unchanged.