I, have read and understand the conditions of the Kurt Caselli Safety Foundation Scholarship. I affirm that I am a current or former racer as defined in those documents. I give permission to officials of my institution to release transcripts of my academic record and other information requested for consideration in the Kurt Caselli Scholarship program. I understand that this application will be available only to qualified people who need to see it in the course of their duties. I affirm the information contained herein is true and accurate to the best of my knowledge and belief.