Please initial here. (page 2 of 4 total pages) I agree that in the event I fail to meet the terms or circumstances listed above, I will no longer be eligible for additional Build Dakota Scholarship funds. I understand that I may cancel this scholarship while I am a full-time student by repaying all proceeds that were issued for my benefit, provided that all of the proceeds are repaid prior to the end of the semester in which the decision to cancel the scholarship is made. If I am unable to repay the funds prior to the end of the semester in which the decision to cancel the scholarship is made, the scholarship will convert to an interest-bearing loan and I must pay back the scholarship, applicable interest, collection costs and attorney fees for the portion of the scholarship I received, to date. Appeals for extenuating circumstances will be taken to the Build Dakota Scholarship Administration Board. I authorize the Governor of South Dakota, the Build Dakota Scholarship Administration Board or its agents and the technical institute at which I have accepted the scholarship to publically release my name, school (if applicable) and city when announcing the Build Dakota Scholarship recipients. I authorize the Build Dakota Scholarship Administration Board or its agents to release information pertinent to this scholarship to the references listed below, my future employers and to members of my immediate family. In signing this agreement, I accept that it is fair and binding. I understand and accept all of the terms and conditions of the agreement and will adhere to them. The authorizations I have made will stand throughout my education and employment commitment. If I choose to alter any authorization, I must provide directions for change in writing to the Build Dakota Scholarship Administration Board. Under penalty of perjury, I certify that the information I have provided on the Build Dakota Scholarship Acceptance Agreement is true, complete, and accurate to the best of my knowledge. SAMPLE Signature of Build Dakota Scholar Date Parent/Guardian Signature, if Scholar is under the age of 18 Date The information provided on this Acceptance Agreement will be shared and released as authorized in the agreement, including verifying education and employment records. The scholarship recipient’s Social Security Number may be used as an account identifier. Should the scholarship convert into an interest-bearing loan, this information will be used in the servicing and collection of that loan. Please make any correction necessary on any pre-filled areas (obtained from your scholarship application), and complete fully the remaining areas:
Appears in 1 contract
Please initial here. (page 2 of 4 total pages) I agree that in the event I fail to meet the terms or circumstances listed above, I will no longer be eligible for additional Build Dakota Scholarship funds. I understand that I may cancel this scholarship while I am a full-time student by repaying all proceeds that were issued for my benefit, provided that all of the proceeds are repaid prior to the end of the semester in which the decision to cancel the scholarship is made. If I am unable to repay the funds prior to the end of the semester in which the decision to cancel the scholarship is made, the scholarship will convert to an interest-bearing loan and I must pay back the scholarship, applicable interest, collection costs and attorney fees for the portion of the scholarship I received, to date. Appeals for extenuating circumstances will be taken to the Build Dakota Scholarship Administration Board. I authorize the Governor of South Dakota, the Build Dakota Scholarship Administration Board or its agents and the technical institute at which I have accepted the scholarship to publically release my name, school (if applicable) and city when announcing the Build Dakota Scholarship recipients. I authorize the Build Dakota Scholarship Administration Board or its agents to release information pertinent to this scholarship to the references listed below, my future employers and to members of my immediate family. In signing this agreement, I accept that it is fair and binding. I understand and accept all of the terms and conditions of the agreement and will adhere to them. The authorizations I have made will stand throughout my education and employment commitment. If I choose to alter any authorization, I must provide directions for change in writing to the Build Dakota Scholarship Administration Board. Under penalty of perjury, I certify that the information I have provided on the Build Dakota Scholarship Acceptance Agreement is true, complete, and accurate to the best of my knowledge. SAMPLE Signature of Build Dakota Scholar Date Parent/Guardian Signature, if Scholar is under the age of 18 Date The information provided on this Acceptance Agreement will be shared and released as authorized in the agreement, including verifying education and employment records. The scholarship recipient’s Social Security Number may be used as an account identifier. Should the scholarship convert into an interest-bearing loan, this information will be used in the servicing and collection of that loan. Please make any correction necessary on any pre-filled areas (obtained from your scholarship application), and complete fully the remaining areas:
Appears in 1 contract