Annual Scholar Report

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Hello Scholars,
You will need to allow time to complete this form as it covers several topics including your current academic studies and your Annual Scholar Report & Narrative for continuing Scholars.

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General Information

Legal First Name

Legal Last Name

Preferred First Name

Gender

Self-Identify

If you selected "Self-Identify Other," please complete this field.

Preferred Pronouns

Cell Phone Number

Primary email address (For new Scholars, please do not use a high school email address that will expire soon. For graduating Scholars, please use the email you'd like us to contact you with after graduation.)

Annual Information & Agreements

Please select the category which most applies to you:

New or Continuing ScholarGraduating Scholar (completed undergraduate degree)

I am a...

New ScholarContinuing Scholar

Please select your scholarship award year.

What is your mailing address this summer?

City

State

Zip Code

From which high school did you graduate?

Which college are you attending?

Undergraduate Work

Degree

Expected Graduation Date

Spring Semester/Quarter GPA

Cumulative GPA

Major(s)

Minor(s)

Graduate Work

Degree

Field

Scholarship Release Forms:

Your first step is to sign several release forms related to the administration of your Boettcher Scholarship. Please complete each form and submit them using the process below.

Step 1: Please sign in to our Current Scholar Portal using the same login credentials you used to sign in to your scholarship application.

Step 2: Once you’ve signed in, go to the tab at the top of the page to access “Documents & Forms”, and then scroll down to the section titled “Release Forms”. Click on the links to access the following forms:

· FERPA Release Form

· Liability Release Form

· Publicity Release Form

· Information Release Form

Step 3: Please download and sign the forms.

Step 4: Then scan or save them as PDF documents. ***Please name the files using the following format: "Last Name, First Name - (insert name - one of the following FERPA/Liability/Publicty/Information) Release Form"

Step 5: Submit all forms via the upload links below.

Please upload your signed FERPA Release Form.

PDF Only

Please upload your signed Liability Release Form.

PDF Only

Please upload your signed Publicity Authorization & Release Form.

PDF Only

Please upload your signed Information Release Form.

PDF Only

Rules, Regulations, and Requirements of the Boettcher Scholars during Scholars Experience

· Scholar shall attend all functions and activities sponsored by the Boettcher Foundation including (but not limited to):

o Seminars

o Mentor lunch/dinner

o Other group activities

· Scholar shall complete all required pre-work prior to Scholars Experience

· Scholar shall not deviate from the schedule of planned activities.

· Scholar is not to leave the event complex until the event has concluded, except for functions and activities sponsored by the Boettcher Foundation and in transportation provided by the Foundation.

· If transport is provided by the Foundation, Scholar must provide a written exception request if they must drive themselves. Requests must be received by June 15.

· Scholars are not to partake in any drug or alcohol use during Scholars Experience, even if they are of legal age.

· Scholar must behave in accordance with our Code of Conduct policies at all times.

· Scholar must follow all COVID safety regulations at any Scholars Experience venue.

Failure to adhere to the rules provided by the Boettcher Foundation to the Scholar may result in the immediate dispatching of the Scholar and forfeiture of the scholarship award.

By checking that you agree, you are affirming that you have read and agree to the terms detailed in the Rules & Regulations code.

I agree

Boettcher Scholarship Code of Conduct

The undersigned recipient recognizes that it is a privilege to participate in the Boettcher

Scholarship program, and that his/her conduct will reflect on the Boettcher Foundation, his/her university/college and other Boettcher Scholars (both current and alumni). A Boettcher Scholar is expected, in conduct and achievement, academically and otherwise, to be an exemplary citizen of the undergraduate student body of his/her university/college and of the broader community. A Boettcher Scholar is also expected to add to the distinction of the university/college in a constructive and responsible manner while a student, and to continue doing so as a Scholar Alumni. As Boettcher Scholar Alumni you are expected to keep in contact with the Boettcher Foundation, providing updated contact information so that we can continue to offer you ongoing programming opportunities.

As a condition of my acceptance of the Boettcher Scholarship, I agree to the following:

1. ACADEMIC ACHIEVEMENT: A Boettcher Scholar will be expected to complete a minimum of 12 credit hours (or three blocks) each semester/quarter and maintain a minimum cumulative grade point average of 3.0.

2. EXTRACURRICULAR ACHIEVEMENT: A Boettcher Scholar will be expected to participate and make contributions in endeavors outside the regular academic curriculum, which are consistent with his/her abilities, interests and potential, as demonstrated to the Foundation in the Scholar’s application.

3. PERSONAL RESPONSIBILITY: A Boettcher Scholar will be expected to act in a manner that will not bring discredit to himself/herself, other Boettcher Scholars, the Foundation or his/her university/college. A Boettcher Scholar will also be expected to act in a way that is generally consistent with the principles and ambitions presented by the Scholar to the Foundation during the application and interview process.

4. LEGAL RESPONSIBILITY: A Boettcher Scholar will be expected to comply with all federal, state and local laws, and all rules and regulations of his/her university/college. A violation of the law (except minor traffic violations) will be considered sufficient reason for suspension, cancellation, or non-renewal of the award.

5. ADMINISTRATIVE RESPONSIBILITY: Boettcher Scholar will provide the Foundation with a grade release, general liability release, publicity authorization and release, and such other documents and information as may be requested by the Foundation to supervise and administer the scholarship.

Although the Foundation is financially prepared to renew the recipient’s scholarship for eight semesters/twelve quarters of study, all grants are made in advance for one semester/quarter only. Scholarships will be renewed only if, in the sole judgment of the Foundation, the recipient meets the expectations described above and complies with the Foundation’s policies as set forth in the Policies and Expectations section of the Boettcher Scholar handbook, which the Foundation reserves the right to modify at any time. While a copy of this document is provided to all recipients at the time they are offered the scholarship, Scholars may request an updated copy of this booklet at any time. The Foundation may also terminate a scholarship if, in its sole judgment, the recipient engages in conduct that violates the expectations described above.

Any questions regarding the Boettcher Scholarship should be directed to Foundation staff. Staff are always available for individual counsel and will work with each Scholar toward a rewarding career at the Scholar’s chosen university/college and later in life.

By checking that you agree, you are affirming that you have read and agree to the terms detailed in the Code of Conduct.

I agree

Are you 18 years of age or older?

YesNo

By checking that you agree, you are acknowledging that you will be required to submit separate release forms signed by a parent or guardian upon request by the Foundation.

I agree

THIS IS A RELEASE OF LIABILITY IN EXCHANGE FOR PARTICIPATING IN THE BOETTCHER SCHOLARSHIP PROGRAM. BY SIGNING BELOW, I AM AGREEING TO RELEASE THE BOETTCHER FOUNDATION (THE "FOUNDATION") AND OTHER PARTIES FROM LIABILITY. I HAVE READ THIS DOCUMENT CAREFULLY.

1. I recognize that participation in the Boettcher Foundation Scholarship Program (“Program”) is a privilege and voluntary. The Program may have risks associated with participation, such as travel, mental and physical health, safety, and the theft of my data by bad actors. I have made my own investigation and am willing to accept these risks.

2. I recognize that Foundation’s insurance may not provide any insurance coverage for any harm that may befall me while participating in Program activities or travel associated with the Program activities and therefore acknowledge that the Foundation has strongly encouraged me to obtain medical insurance.

3. I fully release the Foundation and its agents, employees, operators, officers, and trustees and all educational partners, vendors, and sites used by the Foundation to provide the Program (collectively “Released Parties”) from any claim for harm, emotional distress, injury, death, loss of property or any other damages which may befall me while participating in this Program, traveling to or from any activity site, or arising from my presence at the site or in the site vicinity, including all health, emergency health treatment and other risks connected therewith, whether foreseen or unforeseen, and whether or not arising from the alleged bad acts or negligence of the Released Parties. It is my intent to release any and all claims of any kind whatsoever against the Released Parties and therefore further agree to indemnify and hold harmless the Released Parties from any claim by my family and estate, my heirs or assigns, personal representatives, and insurers arising out of the Program and my participation in it.

4. This release shall be governed by the laws of the state of Colorado.

In consideration for being permitted to participate in the Program, I agree to this Liability Release. I further represent that I am at least 18 years of age or, if not, that my parents or guardian will have signed this form in the "Consent" section once sent to them by the Foundation.

I agree

Scholarship Decision Survey

Please indicate which of the following statements best describes the impact that receiving the Boettcher Scholarship had on your college choice:

I would most likely have stayed in Colorado for college, regardless of whether I had received the Boettcher Scholarship or not.I would most likely have chosen an out-of-state school had I not received the Boettcher Scholarship.I am not sure whether or not I would have stayed in Colorado for college had I not received the Boettcher Scholarship.

Please indicate how much influence each of the following factors had on your decision to accept the Scholarship:

	Great Deal of Influence	Some Influence	Neutral	Not Very Much Influence	No Influence
The honor and/or prestige associated with being a Boettcher Scholar
The monetary value of the scholarship
The opportunity to apply for additional funding through an International Education Grant or Educational Enrichment Grant
The number of opportunities I anticipate will become available to me as a Boettcher Scholar
My desire to stay in Colorado for my college and my career
The quality of Colorado institutions
My desire to be "close to home"

Other important factor(s) (Please specify):

Please rate the following factors based on how important they were in your decision regarding which school to attend:

	Very Important	Important	Neutral	Not as Important	Didn't Consider
Location of the campus
Academic programs
Co-curricular/other programs
Reputation of the school (overall)
Talking to current Boettcher Scholars or other current students
Public vs. private school
Visiting the campus
Additional scholarships offered to you by the school
Size of the school
Choice of majors
Opportunities for dual degree programs (combining undergraduate and graduate work through a 4+1 or 3+2 program)
Opportunities to study abroad
Tuition waiver for 5th year of schooling
Opportunities for post graduate fellowships (Rhodes, Fulbright, Truman, etc.)
Experience at the Boettcher Finalist Day
Early admittance to specialized graduate program (law, medicine, veterinary sciences, etc.)

Other important factor(s) (Please specify):

Is there anything else you would like to share about your decision process or your choice of college/university?

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