LEAD Scholarship Acceptance Form

Congratulations on being selected to join the LEAD Scholars Program, offered by the Alumni Association of the University of Michigan.

Please complete the form below to accept or decline your offer.

Questions or concerns?

For questions about the LEAD Scholarship and/or the selection process, please contact aaumleadscholars@umich.edu.

Acknowledgement of Scholarship Acceptance

By signing this form, you are confirming your intent to enroll at the University of Michigan and accept the LEAD Scholarship offered by the Alumni Association. Your commitment also includes attending any required events scheduled, as this is a key requirement to continue receiving the scholarship.

I will accept your scholarship offer and will enroll at the University of Michigan (Ann Arbor, Dearborn, or Flint).

I am declining your scholarship offer and will instead be attending another institution

Name of College or University

Scholar Information

First Name

Last Name

Address:

Address 2 (Apartment, lot, suite or other)

City

State/Province/Region

Zip Code (if available)

Country

High School

U-M ID Number

Uniqname (your U-M login ID)

DO NOT include "@umich.edu"

Award Amount

Award Amount (per year):

Upload Photo

Please upload a professional photo of yourself. (Please note: High School "cap & gown" photos should not be submitted).

Release of Information *

I give the Alumni Association permission to publicly announce my acceptance of this award and grant permission to use my likeness, name, city, state and other demographics and photograph(s) in any and all of its publications and in any and all other media, whether now known or hereafter existing, controlled by the Alumni Association, in perpetuity.

I understand that maintaining my GPA at or above a 2.0 is a requirement to continue receiving this merit-based scholarship, renewable for up to a total of 4 years. I also authorize the release of my GPA and/or transcripts to the Alumni Association in order to verify my grade point average.

Signature Notice

Whether you accept or decline the LEAD Scholarship Offer, you must sign with your signature at the end of this form. This offer will not be considered complete until your signature is entered and submitted. The signature field asks for your signature OR to type your name. Please sign AND type your name for verification purposes.

I Understand

Scholar Interests

Please list the extracurricular activities you participated in during High School.

Which U-M School/College were you admitted to?

Intended Major / Academic Interests

Occupational Goals

Unique Skills or Talents

Comments

Contact Information

Phone number (cell):

Phone number (permanent):

About the Scholarship

How did you hear about the LEAD Scholarship?

Other: