Personal Information

Email

Educational Information

High School Attending

HS Graduation Year

GPA

Parents Information

Parent Email

Survey and Consent

Media Consent

I hereby authorize the Urban League of Rochester, NY, Inc. (hereafter ULR) to use my photo(s) and/or information related to my experiences with the Early Recognition and Black Scholars Programs. I understand that my photo(s) and/or information may be used in publicity materials for ULR, including web publications, community audio/visual presentations, letters, media publications, and other similar ways. ULR will disclose to me or my legal representative, where appropriate, the specific information and/or photo(s) to be used prior to release on any social media platform. My consent to opt-in electronically is freely given as a public service to the Early Recognition and Black Scholars Programs without expectation of payment. I release ULR and their board members, executive leadership, and employees from any liability that may arise from the use of my information in the manner described above. By opting in, I understand that I can revoke this release at any time in writing and that the use of any of my photos or information authorized by this release shall immediately cease.

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Black Scholars Contact Information

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