PARTICIPATION APPLICATION/AGREEMENT TCT, along with other business and community partners, in conjunction with the Northwest College Foundation, the Big Horn Basin Health Coalition and local schools, are proud to support the youth of our communities through an unprecedented scholarship fund for grades 6-12. The goal of Today’s Choices for Tomorrow is to make available a $150 scholarship* every semester for students in our area, with a potential total amount of $2,100 for a student beginning the program in the 6th grade. Following graduation, this money will then be used by the student for post-secondary education or training. Overall, we hope this will give more students the opportunity to gain skills and be more valuable to a potential employer and themselves!
Student’s legal name_______________________________ M_____ F_____ Date_______________ Date of birth_______________ Social Security #___________________________________________ School_____________________________ City_________________________ _ Grade_____________ Home address________________________________ City_____________________ Zip___________ Mailing address________________________________ City_____________________ Zip___________ Phone #______________ Cell phone #_______________ E-mail address_ ______________________ Name of student’s parent(s) or guardian(s)__________________________________________________ Student agreement: I agree to earn a minimum grade point average (GPA) of 2.0 each school semester, be involved in healthy youth activities and participate in community service activities. I will strive to follow school rules and all local laws, demonstrate excellent behavior and serve as a positive role model for younger students to contribute to a positive image of Today’s Choices for Tomorrow. If my GPA falls below 2.0, I will have a one-semester probationary period to return it to a level equal to or above 2.0. If I fail to do so after this probationary period, I understand that I will be placed on inactive status. If my GPA improves to this level at a later time, I may be invited to return to the program. I fully understand that my participation in Today’s Choices for Tomorrow is voluntary, and that I may quit at any time. Parent/guardian agreement: I am providing consent for __________________________ (student’s name) to participate in Today’s Choices for Tomorrow during middle and/or high school enrollment. This includes my authorization for all activities related to this student: (1) release of all school records; (2) consulting/coordinating services with school staff and other community programs; (3) participation in program activities; (4) participation in preventative random drug testing program (if available as part of school’s extracurricular activities policy).
Student applicant signature________________________________________ Date_________________ Parent/Guardian signature_________________________________________ Date_________________ Submit completed application to your school couselor or to Project Director Chad Lindsay, Big Horn Basin Health Coalition, 502 Hampshire Ave., Lovell, WY 82431. For more information on this program please call 307-548-6410. *Amount of scholarship awarded each semester dependent on available funding. Scholarship awarded to student upon high school graduation and must be applied to a qualified program.