2021 Rogers Scholars Week 2 Acceptance | Youth Programs at The Center for Rural Development

Congratulations! If you received a letter of acceptance for the Week 2 of the 2022 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 your LWC paperwork that was included in your acceptance packet and provide a copy of the front and back of your insurance card.

If you have any questions, please contact Allison Cross at across@centertech.com or call 606-677-6019 or 606-307-0561.

2022 Rogers Scholars Week 2 Acceptance Paperwork

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Rogers Scholars @ LWC - Acceptance Paperwork

Below is the 2022 Rogers Scholars Acceptance Form for Rogers Scholars Week 2 at Lindsey Wilson College.

Please read this form carefully before submitting as it includes information regarding medical care and rules and regulations for camp.

Please submit the form by the March 23rd deadline. If you do not fill out the form by the deadline, you will forfeit your position in the program.

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

-Section 1: Contact Information - Your basic information

-Section 2: Parent Information - You will need emergency contact information

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

-Section 4: Important Note to Parent(s)/Guardian(s)

-Section 5: Community Service Requirement

-Section 6: Code and Conduct

-Section 7: Media Release

-Section 8: Health Insurance and Release Form: Upload a front and back copy of your health insurance card.

-Section 9: COVID Liability Release

-Section 10: Upload LWC Paperwork that you received in your packet.

Section 1: Contact Information

First Name *

Last Name *

Please list your preferred name if different from your legal name. This will go on your name badge.

County *

School Name *

Date of Birth *

Shirt Size *

Student Email Address *

Please use an email that you check on a regular basis.

Parent/Guardian Email Address *

Please use an email that you check on a regular basis.

Address *

City *

State *

Zipcode *

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 Allison Cross at 606-307-0561.

If you are human, leave this field blank.