final parent handbook 2015 2201_2015parentshandbook_withedits_4printer

Partner School Scholarship

RESOURCEGUIDEFOR PARENTS& STUDENTS

2201_ParentsHandbook_withEdits.indd 1 4/20/15 10:51 PM

Contents

01040608101217

Introduction to GSBF

Student Activities

Information While in College

The Mentor Program

Glossary of Terms

Required Forms

GSBF Photos

“ I remember thinking: If I ever get rich, I’m going to do something like this for someone who could use a boost.”Bob Carr, Founder, GSBF


Introduction to GSBFThis booklet is designed to provide students with information on GSBF events and

other foundation facts. There may be situations that arise that could affect a student’s status in the program. This packet will address those issues, who to contact and the responsibilities as a GSBF Scholar. Once students are a part of GSBF, our goal is to provide families with as much help and information as possible to ensure the time with the program is successful and fulfilling.

The GSBF Partner School Scholarship is designed to prefund the cost of college for students who are freshmen in high school, are people of high character, have a high level of academic achievement and are eligible for a full Pell Grant. Students will have the choice to attend one of our partner schools: University of St. Francis in Joliet, IL, Lewis University in Romeoville, IL and Blackburn College in Carlinville, IL. GSBF students can expect that the Foundation will invest significant resources in both academic and non-academic activities for their enrichment.

GSBF wants students to think about “giving back” to their community in the future by donating either talents or treasure. However, an immediate way to ensure that students have a great experience will be to cooperate with GSBF by attending events and adhering to the important guidelines.

More than a ScholarshipGSBF will provide students with many

opportunities that are non-academic in nature to provide preparation for college and for life. These mandatory events will expose students to practical skills (FAFSA workshop, networking events, etc.) and introduce them to interesting people and concepts throughout their time in high school. The scholarship is the reward at the end of successful completion of the GSBF sponsored activities throughout high school.

Resident and Non-Residential College Options

GSBF students will eventually commit to one of the three partner schools. Blackburn College is the option for students who wish to live on campus, whereas Lewis University and University of Saint Francis will be for commuters. At Blackburn College, GSBF students are required to live on campus (subject to approval.) GSBF will pay for the balance of the tuition, room and board expenses. Room deposits, fines and any additional fees are not covered by the scholarship.

Our goal is to provide students and their families as much help and information as possible to ensure their time with the program is successful and fulfilling.

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Contact ExpectationsIt is very important for students to check

email and voice mail regularly during their career in the GSBF program because they will receive regular emails, telephone calls and other communications. Students are required to respond in a timely manner as much of the work/activities require strict deadlines.

In turn, students can expect GSBF to respond to communications/questions within 24 hours.

Students can contact GSBF by email [email protected] or contact us via telephone at 815-834-8400. Any GSBF staff member will be happy to assist students.

Family Information It is very important that GSBF has the

most up to date contact information for each family. Examples can be changes to cell phone numbers, home address or email. Please contact GSBF immediately should any information need to be adjusted at [email protected] or contact us via telephone at 815-834-8400.

Eligible high schools in Will County:

GSBF currently is working with 21 high schools in Will County, Illinois. Most GSBF events will be held at a centrally located high school or one of the local partner colleges (Lewis University or University of St. Francis.)

The high schools are:

• Beecher High School• Bolingbrook High School• Crete-Monee High School• Joliet Catholic Academy• Joliet Central High School• Joliet West High School• Lincoln-Way Central High School• Lincoln-Way East High School• Lincoln-Way North High School• Lincoln-Way West High School• Lockport Township High School • Neuqua Valley High School• Peotone High School• Plainfield Central High School • Plainfield East High School• Plainfield North High School• Plainfield South High School • Providence Catholic High School• Reed-Custer High School• Romeoville High School• Wilmington High School

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Academic Requirements Students who are chosen to receive a GSBF

Scholarship need to graduate with a minimum cumulative grade point average (“GPA”) of a 3.0 (“B”

average) on a 4.0 scale. If the high school’s grade point average is calculated on a 5.0 scale, the equivalent “B” average will apply.

Because the transition from junior high school to high

school can be difficult for various reasons, the minimum GPA requirement for the first year is 2.75. However, at the conclusion of the student’s sophomore year, the cumulative GPA is required to be above a 3.0. Please note, it is very important for students to work as hard as possible because not only is it hard to recover from a difficult semester it also provides some cushion should academic difficulties arise while in high school.

While in college, GSBF requires that the student remains in “good standing.” Good standing can relate to academic achievement as well as the university’s behavior policies or codes of conduct.

Students who do not meet the minimum requirements for GPA generally are placed on probation for a semester and given an opportunity to improve their scores. If the minimum cumulative GPA cannot be achieved, the student will be reviewed for further participation in the GSBF program.

“ I have tremendous admiration for Bob Carr and am awed and inspired by his personal and business stories. To be able to support his vision and generosity is an honor.”

Judith FoxGSBF Board Member

3.0minimum high school

cumulative GPA

Student Academics GSBF will be monitoring student grades

throughout the entire program. It may be possible that it will be the student’s responsibility to send grades each semester to GSBF. If a student finds that they need academic assistance, they can contact GSBF. In many cases, tutoring can be arranged through our partner universities.

GSBF MENTOR

“ I became a mentor because I had an influential mentor in my life and I truly valued the support they had given me. Through the experiences I had throughout high school and university, I believe I can help other students achieve their goals and really be the best person they can be, academically and personally. The Give Something Back Foundation mentor program is one of the best that I’ve come across and it’s been a huge honor to be a mentor in the program.”

Helen DicksonFinancial Services Coordinator

GSBF BOARD MEMBER

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9th GRADE

Students are chosen for GSBF in March. There will be no mandatory activities in which to participate with the exception of the GSBF Annual Dinner (please see page 5.)

10th GRADE

Meet an Interesting Professional – GSBF will bring in a person to speak to the students on topics that will enrich their perspectives. Speakers will rotate depending on schedules.Success/Choices Workshop – This will focus on being successful and making good choices. There will be a special section focusing on social media and subsequent ways to be protected when utilizing these sites and the Internet.Raymond Benson – Famous author and computer games designer Raymond Benson will discuss his life and encourage students to pursue a college degree and their dreams.College Tour – This will take place during the summer before students begin junior/senior year. This is designed to provide the opportunity to begin thinking about college fit (i.e. size, location, distance from home, etc.) and experience different college campuses.

GSBF will sponsor several activities while students are in both high school and college. At all events, GSBF scholars are asked to show appropriate behavior by providing their full attention, wearing appropriate clothing and arriving in a timely fashion. During events, GSBF asks that students refrain from using cellphones or other electronic device unless requested to do so. If students need to contact their parent/guardian for an emergency, we ask that they request permission from a GSBF staff member.

All events are considered mandatory and are subject to change. However, GSBF events are posted far in advance on the GSBF website. Failure to attend or being unexcused (not responding to GSBF invitations or communications) may affect a student’s scholarship status.

RSVP for an event or contact GSBF via telephone at 815-834-8400 or email at [email protected].

Student Activities HIGH SCHOOL

Current events include:

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GSBF Roundtable – Each semester, GSBF students will come together for a meal and have a topic for discussion.

GSBF Annual Dinner – New and alumni students will enjoy an evening of fellowship and enjoy comments by Bob Carr, Founder of GSBF.Christmas Event – All students will participate in an event around Christmas break. It is generally an event used to introduce students to each other.

11th GRADE

Etiquette Dinner – The purpose is to educate and inform students about proper etiquette (i.e. general etiquette, introductions, dining tips, etc.) Career Assessment – University of Saint Francis will work with GSBF to administer a personality/career test and review the results and apply the information to the available majors of the partner schools.

12th GRADE

College Panel – This panel is for senior students and their parents about choosing and applying to college. The panel will be made up from partner schools, large and small colleges, as well as private and public universities.FAFSA Workshop – All GSBF parents and students will participate in a FAFSA Workshop conducted at Lewis University. The Financial Aid Office of Lewis University will walk GSBF families through the FAFSA and officially complete the form to be processed.College Adjustment/Finance Workshop – This will be presented by an affiliate college/university for all GSBF Seniors and their families. Topics to be discussed will be adjusting to college, living on campus, budgeting expenses, etc.

HIGH SCHOOL

WHILE IN COLLEGE

ALL YEARS

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Free Application for Federal Student AidEach GSBF scholarship recipient is required to file

the Free Application for Federal Student Aid (FAFSA), every year that they are attending college. Students are

strongly encouraged to file the FAFSA by January 31 (online at www.fafsa.gov.) It is very important that students meet all federal, state and institutional deadlines, failure to do so could cause the student or their

family to financially contribute towards the degree. It is also important that students respond to any additional institutional requests for information or verification.

After students successfully file the FAFSA, it could be determined that a student/family may need to contribute toward their education. Instances can include:a. If the combined family household income is

$60,000 or more. b. The Expected Family Contribution (EFC), as

determined by FAFSA, is more than $0.

If a situation like this arises, GSBF will work with families to find the best solution. The goal of the Foundation is to help families navigate all aspects of the college experience. The earlier GSBF knows about financial changes within a student’s family, the better we can assist the student. The Foundation can be contacted by email [email protected] or via telephone at 815-834-8400.

File FAFSA by

January

31

Dropping Below Full –Time Status

Students must be enrolled and remain full-time (minimum 12 hours), while in college each semester. Please note that each university/college may define “full-time” differently than GSBF. GSBF will view dropping below full-time status (12 hours) as “withdrawing from a class (“W” on a transcript) or receiving an incomplete (“I” on a transcript), as less than full-time.

It is the student’s responsibility to notify GSBF if a situation arises and they are enrolled in less than 12 hours per semester. Students need to advise GSBF staff of course adds or drops.

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Self-Evaluation PaperBy June 30, at the end of each academic year of college, each

GSBF scholar is required to submit a paper to the foundation evaluating and reflecting on that year of college.

This paper should:

1. Discuss a few significant achievements or realizations from the entire academic year.

2. Touch particularly upon the following year-specific topics:a. Freshman year - adjustment to the college/university

environment, relationships with faculty and experiences outside of class with extracurricular involvements.

b. Sophomore year - coursework and lessons, decisions and interests about majors, minors and other areas of study.

c. Junior year - experiences of leadership in major or extracurricular activities, thoughts, feelings and goals the student has about the coming final year of college and career/post-college plans.

d. Senior year - reflection on the entire four-year experience of school, goals and hopes for the future mentioning a few specific steps, involvement with the foundation and thoughts about giving back in the future.

These papers are not “graded,” but because they are shared with the board and founder, foundation staff may require edits or rewrites if anything is considered unsatisfactory or inappropriate for college-level writing or treatment of the topic. The foundation will provide a more specific, yet simple, style sheet to inform students on ways to format and submit their letters. In general, the papers should be at least two, double-spaced pages.

Study AbroadGSBF students who

enroll in a university-sponsored, for-credit study abroad program and are eligible for all the financial aid they would normally receive on campus during the “traditional” semester may be eligible to participate in a study abroad program. Students need to provide notice to GSBF staff if they intend to participate in a study abroad program because if it is determined that travel adjustments are necessary, leaving an ample amount of time to make those changes will lower anxiety and provide enough time to accommodate alternative plans.

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The overall goal of the GSBF Scholarship program is to have each student conclude his or her high school career with at least a 3.0 grade point average, have good character and a desire to pursue a 4-year bachelor’s degree. There are many factors that contribute to a student’s success, and one of those is having a mentor.

Young people today have to deal with stresses and issues at an earlier age than ever before. Also, it is certainly fair to say that these same issues are unique to this generation (instant access, information availability, etc.). These issues punctuate

the great and distinct value in developing a mentoring relationship with another person who is older, committed to listening, asking questions to understand and seeking to help the student identify resources and options.

Mentors are considered a necessity in the GSBF scholarship program because they help to ensure student success. Especially in situations where students might be at-risk or when a student struggles with a particular subject area, a behavior problem or maybe a disability, a mentoring relationship can be pivotal. However, even with those students to whom good grades come easily, or who have family situations that are ideal, even then mentoring is of great value and benefit to the student.

Mentors can help to provide academic support , encouraging students to keep working, tutoring at times and certainly helping to direct them to other educational resources.

Mentors are role models demonstrating actions, habits and values that are necessary to being a good person. Even when both parents, other family members and neighbors provide positive examples, the mentor can be one more example, or maybe a connection to a specific career network.

The Mentor Program at GSBF

Benefits of Mentors

BENEFITS TO STUDENTS

• Improved academic and cognitive skills.• Reduce likelihood of risky behaviors (i.e., drug use.)• Positive social attitudes and relationships.• Increased self-esteem.• The positive example of a successful adult.

BENEFITS TO MENTORS

• Personal satisfaction of doing meaningful work.• Better understanding of students and young people.• Improved interpersonal skills.

BENEFITS TO THE GSBF

• More students successfully move on to college.• More students complete college.• More and varied connections in the

local community.

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The Mentor Program at GSBFMentors provide attention most often by simply listening . Mentors can be a sounding board and person with whom to share thoughts, ideas, goals, and dreams. (A mentor might be the only adult in a student’s life who can withhold judgment.)

Mentors provide accountability , setting expectations with the student and asking about progress, expecting results, challenging shortfalls and lifting up accomplishments.

Mentors Expectations• Communicate with students once every

two weeks during the school year- approximately 10 times a semester.

• Talk pointedly about school (grades, classes, extracurricular involvements) and other good and challenging elements of high school (peer pressure, dating and other difficulties.)

• Talk to students about themselves, their health and happiness, stress and their families.

• Be responsive to the needs of the students. Mentors need to listen constantly, be supportive and challenging when necessary.

• Be consistent with and committed to the students, and communicative with GSBF by providing regular updates. Especially when there are causes for concern, mentors should contact GSBF staff.

• Be an additional resource for students.

Students Expectations• Actively participate in communication

with their mentors.• Speak candidly with mentors about

school and any impediments to success. • Be truthful with mentors.• Let GSBF know if communication

difficulties arise!

The foundation’s active interest in the scholarship recipients sets it apart from other organizations. GSBF gives their students guidance and opportunities above and beyond financial support. The mentorship program, FAFSA assistance and college visits are unique aspects of a program designed to give students every possible advantage. GSBF is a truly inspiring organization that helps make dreams come true!

Shannon Stoffey-KeagleTax Attorney

GSBF ALUMNAE AND MENTOR

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Academic Advisor/Counselor: This person will help the student select the correct courses, review the course requirements in the chosen field, and help with any academic problems the student may encounter.

Alumni: People who have graduated from a college/university.

ACT: These letters are acronyms for the American College Test which are designed to measure a student’s level of knowledge in basic areas such as math, science, English and social studies.

Application: The process by which a prospective student submits the required forms and credentials to his/her chosen institution. Application criteria may include one or more of the following: previous academic records, test scores, interviews, recommendations, and other information provided by the applicant.

Acceptance: The decision to accept the application is positive.

Admission: The status granted to an applicant who meets the prescribed entrance requirements of the institution.

Associate Degree: This is granted upon completion of a program of at least two, but less than four years of college work.

Bachelor’s Degree: This is the undergraduate degree offered by four-year colleges and universities.

Catalog: College catalogs provide all types of information parents and students need to know about a school. They list, for example: the institution’s history and philosophy, policies and procedures, its accreditation status, courses of study, degrees and certificates offered, physical facilities, admission and enrollment procedures, financial aid, student life activities, etc.

CLEP: The College Level Examination Program can be administered to students who desire to obtain college credit by taking proficiency tests in selected courses. If the student scores high enough on the test, college credit can be awarded.

College: A college is an institution of higher education that grants degrees and certificates. The term is also used to designate the organizational units of a university such as the College of Education or the College of Engineering.

Financial Aid: Aid for paying college expenses is made available from grants, scholarships, loans and part-time employment from federal, state, institutional and private sources. Financial aid from these programs may be combined in an “award package” to meet or defray from the cost of education. The types and amounts of aid awarded are based upon financial need, available funds, student classification, academic performance, and sometimes the timeliness of application.

Glossary of GSBF Terms

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Glossary of GSBF Terms

FAFSA: Stands for Free Application Federal Student Aid. This application must be filled out every year by January 31 in order to obtain maximum aid.

Commuter College: Some colleges do not have on-campus housing, and all students live off campus and commute to the college for classes.

Credit Hours: Courses taken in college are measured in terms of credit hours. Laboratory classes will require more class time per credit hour. Typical college classes are 3 credit hours, but college classes can range from less than one credit hour to 12 or more credit hours.

Lecture classes: In lecture classes, students attend class on a regular basis and the instructor lectures on class material.

Laboratory classes: Require students to perform certain functions in controlled situations that help them test and understand what is being taught in the lecture.

Pell Grant: The Federal Pell Grant Program provides need-based grants to low-income undergraduate students to promote access to postsecondary education.

Syllabus: A course syllabus is summary of the course. It usually contains specific information about the course; information on how to contact the instructor, including the instructor’s office location and office hours; an outline of what will be covered in the course, with a schedule of test dates and the due dates for assignments; the grading policy for the course; and specific classroom rules. It is usually given to each student during the first class session.

Transcript: The transcript is a permanent academic record of a student at a college. It may show courses attempted, grades received, academic status, and honors received.

Undergraduate: An undergraduate is a student who is pursuing either a certificate or an associate or bachelor’s degree.

University: A university is composed of undergraduate, graduate and professional colleges and offers degrees in each.

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Give Something Back Foundation

The Give Something Back 2015 Student Scholarship Program

GSBF Student Expectations While in High School

While students are given every opportunity to succeed in the GSBF Scholarship Program, certain critical rules will apply. Violation of these rules could affect the student’s status with GSBF.

1. Attend one of the participating high schools in Will County.

2. Uphold a high level of personal integrity throughout their tenure in high school. Students need to avoid unethical behavior (drug use, theft, general negative behavior, etc.) and be people of good character.

3. Students who are chosen to receive a GSBF Scholarship must graduate with a minimum Grade Point Average (“GPA”) of a 3.0 (“B” average) on a 4.0 scale. (If the high school’s grade point average is calculated on a 5.0 scale, the equivalent “B” average will apply.) However, because of difficulties with transitioning from junior high school to high school, students can attain a minimum 2.75 cumulative GPA at the conclusion of their freshman year and a minimum 3.0 cumulative GPA thereafter.

4. Student grades will be monitored each quarter. Students who fall below GSBF GPA parameters mid-semester may receive a letter of caution and may meet with the GSBF staff.

5. Recipients are encouraged to take a minimum of three Honors (or Advanced Placement) courses during their four year tenure in high school.

6. Recipients are required to take coursework that is considered “college preparatory.” When choosing or changing classes, always obtain approval from GSBF.

7. Each GSBF scholarship recipient is required to file the Free Application for Federal Student Aid (FAFSA). This must be completed no later than January 31 during your senior year of high school and each year thereafter in college. Failure to do so could cause the student to financially contribute towards the degree.

8. Students are expected to attend all GSBF functions and events.

9. If contact information changes (address, telephone, email, etc.) recipient is responsible to notify GSBF immediately.

10. Students will be required to choose with Lewis University, University of St. Francis or Blackburn College by January of senior year of high school.

11. GSBF students must inform GSBF of a “change in life situation.” Examples of this could include (but are not limited to) financial situation, marital status, etc.

I understand what is expected of the student and agree to comply with the requirements of GSBF.

Date _____________________ Signature (Parent) ___________________________________________________

Date _____________________ Printed Name (Parent) ________________________________________________

REQUIRED FORM: Expectations While in High School

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GSBF Student Expectations While in College

While students are given every opportunity to succeed in the GSBF Scholarship Program, certain critical rules will apply. Violation of these rules could affect the student’s status with GSBF.

1. Recipients will provide GSBF year-end college transcripts and an essay in relation to their college experience by June 30 every year (See Self-Evaluation Paper on page 7 in the Resource Guide for Parents and Students.)

2. Students will be enrolled and remain full-time (minimum 12 hours.) Dropping below full-time status due to withdrawing (“W” on a transcript) or receiving an incomplete (“I” on a transcript) will be viewed by GSBF as less than full-time. Please note that the university/college may define full-time differently than GSBF.

3. Being placed on institutional probation may impact student status with GSBF.

4. Each GSBF scholarship recipient is required to file the Free Application for Federal Student Aid (FAFSA)every year they are attending college. Students must meet all federal, state and institutional deadlines.

5. At Blackburn College, GSBF will pay for the balance of the tuition, room and board expenses (student must live in “official” university housing.) Housing is subject to approval by GSBF.

6. GSBF Scholarship is valid for eight consecutive semesters (Fall/Spring.)

7. GSBF students who enroll in a university-sponsored International Study Abroad and are eligible for all the financial aid they would normally receive on campus during the “traditional” semester may be eligible to participate.

8. If circumstances change for you or your family that affect your ability to receive or qualify for the scholarship, please contact GSBF immediately.

Date _____________________ Signature (Parent) ___________________________________________________

Date _____________________ Printed Name (Parent) ________________________________________________

REQUIRED FORM: Expectations While in College

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REQUIRED FORM: Release Form



Release Form

I grant permission to the Give Something Back Foundation (hereafter referred to as the Foundation) and its agents or employees to inspect and copy any and all “school” student records, including the student’s (hereinafter referred to as the Student) permanent and temporary records, and information regarding the Student referred to below, including, but not limited to, grades and disciplinary actions, that are available at the Student’s High School (hereafter referred to as the HS) at any time without prior notification to or knowledge of the Student or the Student’s parents or legal guardians. I hereby understand that any information obtained by the Foundation in regards to the Student may be shared with persons or institutions that the Foundation deems appropriate.

I hereby release and agree to save harmless the Student’s HS and its employees, agents and independent contractors from any liability in relation to the transfer of information (including, but not limited to, verbal or electronic communications), records or any data in relation to the Student.

I grant permission to the Foundation to communicate with any teachers, coaches, co curricular moderators, administrators or any other individuals associated with the Student’s HS in regards to obtaining information regarding the Student.

I agree to execute all documents reasonably requested by the Foundation to accomplish the foregoing.

I understand and agree that this is a legally binding agreement and confirm that I have had the opportunity to consult with an attorney before executing and delivering this document.

Date ____________________

Student’s Information

Student Name _________________________________

Signature _____________________________________

Parent/Legal Guardian’s Information

I certify that I am the Student’s parent or legal guardian and I give my consent without reservation to the foregoing on the Student’s behalf. Date _________________________________________

Name ________________________________________

Address ______________________________________

_____________________________________________

Phone _______________________________________

Signature _____________________________________

GSBF Representative ___________________________

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Parent Agreement

This is a statement of intentions by _______________ (hereafter referred to as Student), ________________ (hereafter referred to as Parent(s)), and the Give Something Back Foundation (hereafter referred to as the Foundation) related to the program instituted by the Foundation to support students at partnering high schools in Will County. This document is a statement of intention only and is not a legally binding agreement, nor does this document entitle Student or Parent(s) to participate in any program of the Foundation or to receive any benefit from the Foundation.

The student shall:

1. Maintain a grade point average consistent with the criteria of the program.

2. Abstain from the use of alcohol, tobacco or other drugs.

3. Develop habits that reduce the likelihood of disciplinary actions in school or negative contact with law enforcement and the community.

4. Develop positive friendships/networks while participating in activities that support future goals.

5. Ask for help if feelings of anxiety, frustration or being overwhelmed occur.

6. Attend the student-networking functions offered by the Foundation.

Parent(s) shall:

1. Understand that parents/guardians are the most influential person in a child’s life.

2. Develop habits that enable Student to commit to and achieve Student’s obligations.

3. Positively support Student’s efforts in school, and Student’s efforts to develop healthy relationships and form habits that decrease Student’s risk of using alcohol, tobacco and other drugs.

4. Engage in activities and behavior that will assist in reducing Student’s chances of disciplinary actions in school or negative contact with law enforcement and the community.

5. Respond appropriately to Student’s request for help if feelings of anxiety, frustration or being overwhelmed occur.

6. Understand that if Parents’ financial situation changes dramatically when Parents’ child goes off to college, Parents may be required to make a contribution to the Student’s education.

7. Agree to release the Student’s records from the high school that they attend to GSBF for the purpose of fulfilling the intentions described within this document.

The Foundation shall:

1. Provide opportunities for Students to network with each other.

2. Act as a resource to all of the students and parent(s) participating in the program.

3. Support Student and Parent(s) efforts to achieve their goals as described above.

Student, Parent(s) and the Foundation understand that this document is not legally binding, but is a representation of their intentions that are consistent with the “spirit” of the Foundation’s intent to select students who will be attending a Will County High School to participate in the Foundation’s programs. By signature on this document, the Foundation, Student and Parent(s) confirm their intentions to fulfill their respective intentions listed above.

Date _____________________ Signature (Student) __________________________________________________

Signature(s) (Parent/Legal Guardian) ____________________________ ________________________________

Foundation Representative ________________________________________________________________________

REQUIRED FORM: Parent Agreement

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Photo Release Form

I grant permission to the Give Something Back Foundation (hereafter referred to as the Foundation) and its agents or employees, to use: photographs, quotations, name or likeness of ________________________ (hereafter referred to as the Student).

a. I hereby relinquish any right that I may have to examine or approve the completed product or products or the advertising copy or printed material that may be used in conjunction therewith or the use to which it may be applied.

a. I hereby release, discharge and agree to save harmless [photographer] his/her heirs, legal representatives or assigns, and all persons functioning under his/her permission or authority, or those for whom he/she is functioning, from any liability by virtue of any blurring, distortion, alteration, optical illusion, or use in composite form whether intentional or otherwise, that may occur or be created in the taking of said picture or in any subsequent processing thereof, as well as any publication thereof, including without limitation any claims for libel or invasion of privacy.

Student’s Information

Date _________________________________________

Student Name _________________________________

Address ______________________________________

City _________________________________________

State/Zip _____________________________________

Phone _______________________________________

Parent/Guardian’s Information

If the Student is under 18, I certify that I am his or her parent or legal guardian and I give my consent without reservation to the foregoing on his or her behalf. Date _________________________________________

Name ________________________________________

Address ______________________________________

Phone _______________________________________

Signature _____________________________________

GSBF Representative ___________________________

REQUIRED FORM: Photo Release Form

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GSBF AlbumEnjoy some pictures of GSBF students in

action. GSBF purposefully provides students the opportunity to network and know each other.

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For more information, contact us at:

The Give Something Back Foundation, Inc. 16614 W. 159th Street, Suite 301

Lockport, Illinois 60441 (815) 834-8400

FAX (815) 834-8403

[email protected]


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