This document provides information to students and parents about the Partner School Scholarship program from the Give Something Back Foundation (GSBF). The scholarship funds the full cost of tuition, fees, room and board for eligible high school freshmen to attend one of three partner colleges. To receive the scholarship, students must maintain a minimum GPA, complete mandatory activities, and adhere to program guidelines. The document outlines the academic requirements, student activities in high school and college, contact expectations, and other program details. It aims to ensure students have a successful experience and preparation for their future.
2. Contents
01
04
06
08
10
12
17
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
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3. Introduction to GSBF
This 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 Scholarship
GSBF 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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4. Contact Expectations
It 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
info@givesomethingbackfoundation.org 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
info@givesomethingbackfoundation.org 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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5. 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 Fox
GSBF Board Member
3.0minimum high school
cumulative GPA
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 Dickson
Financial Services Coordinator
GSBF BOARD MEMBER
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6. 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
info@givesomethingbackfoundation.org.
Student Activities HIGH SCHOOL
Current events include:
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7. 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.
WHILE IN COLLEGE
ALL YEARS
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8. Information While in College
Free Application for Federal Student Aid
Each 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
info@givesomethingbackfoundation.org or via telephone at
815-834-8400.
File FAFSA by
January
31
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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9. Self-Evaluation Paper
By 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 Abroad
GSBF 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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10. 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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11. Mentors 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-Keagle
Tax Attorney
GSBF ALUMNAE AND MENTOR
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12. 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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13. 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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14. 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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15. Give Something Back Foundation
The Give Something Back 2015 Student Scholarship Program
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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16. REQUIRED FORM: Release Form
Give Something Back Foundation
The Give Something Back 2015 Student Scholarship Program
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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17. Give Something Back Foundation
The Give Something Back 2015 Student Scholarship Program
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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18. Give Something Back Foundation
The Give Something Back 2015 Student Scholarship Program
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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19. GSBF Album
Enjoy some pictures of GSBF students in
action. GSBF purposefully provides students the
opportunity to network and know each other.
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20. 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
info@givesomethingbackfoundation.org
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