Rogers Scholars Alternate | Youth Programs at The Center for Rural Development

Congratulations! If you received a letter of alternate status for the 2022 Rogers Scholars program, you are in the right place. Please fill out the form below. Make sure you have a front and back copy of your health insurance card before filling out the form. This needs to be submitted by March 23. If you have questions, contact Allison Cross at across@centertech.com.

2022 Rogers Scholars Alternate Acceptance

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Rogers Scholars Alternate Acceptance Paperwork

Below is the 2022 Rogers Scholars Alternate Acceptance Form

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

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 as an alternate.

There are 8 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: Important Note to Parent(s)/Guardian(s)

-Section 4: Community Service Requirement

-Section 5: Code and Conduct

-Section 6: Media Release

-Section 7: Health Insurance and Release Form: Upload a front and back copy of your health insurance card.

-Section 8: COVID Liability Release

Section 1: Contact Information

First Name *

Last Name *

Please list your preferred name if different from your legal name.

County *

School Name *

Date of Birth *

Shirt Size *

Student Email Address *

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

Address *

City *

State *

Zipcode *

Alternate Acceptance into the Rogers Scholars Program

Yes, I accept my selection as an Alternate in the Rogers Scholar Program.

No, I will not be able to participate in the Rogers Scholars Program if I were called to attend.

If you are human, leave this field blank.