DAVID L. BROWN MEMORIAL SCHOLARSHIP

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The David L. Brown Memorial Scholarship is awarded by the Geneseo Foundation in the amount of $500 to a senior student of color who has completed at least 5 semesters of full-time study at Geneseo with a minimum 2.5 cumulative GPA.

The awardee must have a demonstrated record of leadership on campus or in the community.

The deadline for receipt of the application is Friday, April 1. (No extensions can be granted.)

Candidate# *

G00123456

Last name *

First name *

Local address *

Local phone number *

With area code and no dashes. 5851234567

Home street address *

Home city *

Home state *

Home zip *

Cumulative GPA *

Home phone number

With country code and area code if applicable.

Please select your major *

* Next to intended major indicates Adolescent Certification available

Please select your minor, if applicable

Africana Studies

American Studies

Asian Studies

Cognitive Science

Conflict Studies

Criminal Justice

Dance

Environmental Studies

Film Studies

German

Graphic Production

Human Development

Information Systems

Integrated Marketing

Latin American Studies

Legal Studies

Linguistics

Medieval Studies

Native American Studies

Organizational & Occupational Behavior

Public Administration

Religious Studies

Urban Studies

Women's Studies

Current leadership position(s) held (up to 3)

Past leadership position(s) held (up to 5)

Write at least 500 words reflecting on what you have gained from the leadership experiences listed above.

PLEASE READ

Please read the following information regarding the Family Educational Rights and Privacy Act and complete the waiver statement below. If you have questions, please contact Fatima Johnson at X5620 or johnsonf@geneseo.edu.

The Family Educational Rights and Privacy Act (FERPA) (20 U.S.C. § 1232g; 34 CFR Part 99) is a Federal law that protects the privacy of student education records. The law applies to all schools that receive funds under an applicable program of the U.S. Department of Education.

FERPA gives parents certain rights with respect to their children's education records. These rights transfer to the student when he or she reaches the age of 18 or attends a school beyond the high school level. Students to whom the rights have transferred are "eligible students."

Parents or eligible students have the right to inspect and review the student's education records maintained by the school. Schools are not required to provide copies of records unless, for reasons such as great distance, it is impossible for parents or eligible students to review the records. Schools may charge a fee for copies.

Parents or eligible students have the right to request that a school correct records which they believe to be inaccurate or misleading. If the school decides not to amend the record, the parent or eligible student then has the right to a formal hearing. After the hearing, if the school still decides not to amend the record, the parent or eligible student has the right to place a statement with the record setting forth his or her view about the contested information.

Generally, schools must have written permission from the parent or eligible student in order to release any information from a student's education record. However, FERPA allows schools to disclose those records, without consent, to the following parties or under the following conditions (34 CFR § 99.31):

School officials with legitimate educational interest;

Other schools to which a student is transferring;

Specified officials for audit or evaluation purposes;

Appropriate parties in connection with financial aid to a student;

Organizations conducting certain studies for or on behalf of the school;

Accrediting organizations;

To comply with a judicial order or lawfully issued subpoena;

Appropriate officials in cases of health and safety emergencies; and

State and local authorities, within a juvenile justice system, pursuant to specific State law.

Schools may disclose, without consent, "directory" information such as a student's name, address, telephone number, date and place of birth, honors and awards, and dates of attendance. However, schools must tell parents and eligible students about directory information and allow parents and eligible students a reasonable amount of time to request that the school not disclose directory information about them. Schools must notify parents and eligible students annually of their rights under FERPA. The actual means of notification (special letter, inclusion in a PTA bulletin, student handbook, or newspaper article) is left to the discretion of each school.

Waiver *

FERPA also protects the privacy of students' official education records, including grades, GPA and disciplinary files. Such information may be examined and discussed in a letter of recommendation only with the written consent of the student.

I waive my right to inspect this letter of recommendation for the Scholarship.

I do not waive my right to inspect this letter of recommendation for the Scholarship.

Permission *

I permit you to examine my Geneseo educational records and discuss them in the letter of recommendation for the scholarship.

I do not give permission for you to examine my Geneseo educational records and discuss them in the letter of recommendation for the scholarship. I waive my right to inspect this letter of recommendation for the Scholarship.

Certification *

By selecting the I confirm button below, I confirm that all of the information provided above is true and correct to the best of my knowledge.

I do not confirm

I do confirm

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