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ROGERS SCHOLARS

Acceptance
Form

Congratulations! If you received a letter of acceptance for the Rogers Scholars Program you are in the right place. Next you will have to fill out the form below. When filling out the form, make sure you have any paperwork that was included in your acceptance packet and a copy of the front and back of your insurance card.
 

There are 10 sections on this form.
Be prepared for the following:

1 | Contact Information
Provide your name, phone number, email, and other essential details so we can stay in touch.

2 | Parent Information
Include emergency contact details and parent/guardian information for safety and communication purposes.

3 | Career Pathway Majors
Here you can select your top major preference you would like to attend while at camp.

4 | Note to Parent/Guardian
A brief but important message for parents and guardians — please take a moment to read before continuing.

5 | Community Service Requirement
Details about the required community service project, including expectations and deadlines.

6 | Code and Conduct
Review the behavior guidelines and expectations all students must agree to before participating.

7 | Media Release
Information about photo/video permissions related to program events and activities.

8 | Health Insurance & Release Form Upload a clear image of the front and back of your health insurance card. This is required for participation.

9 | COVID Liability Release


10 | Upload Paperwork
Upload paperwork that was received in your designated packet.

Need Help?

If you have any questions, please contact:

Amber Decker

606-677-6000

adecker@centertech.com

Please read this form carefully before submitting as it includes information regarding medical care and rules and regulations for camp if you are called to attend.


 If you do not fill out the form by the deadline indicated in your form, you will forfeit your position as a scholar.

Please indicate which Rogers Scholars opportunity you were offered:
Multi-line address
Acceptance into the Rogers Scholars Program :
YES! I accept my selection as a Rogers Scholar and will attend and participate in the program on the dates that I have been assigned.
No, I will not be able to participate in the Rogers Scholars Program. If this is the case, please do not fill out the rest of the form and call Amber Decker at 606-677-6019.
Please select this option if you are unable to attend the assigned dates and would like to discuss a change of assignment. Call Amber Decker at 606-677-6019.
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