Jack Box Scholarship PDF Details

The Jack in the Box Emerging Leaders Scholarship, a collaborative effort between the University of Phoenix and the Jack in the Box Foundation, represents a significant opportunity for individuals seeking to advance their education and leadership skills. Established to support the community of employees, franchisees, and guests associated with Jack in the Box Inc., the foundation provides four full-tuition scholarships. These scholarships are dedicated to aiding prospective students in completing their undergraduate or master's degree programs either online or on-campus at the University of Phoenix. To be eligible, applicants must be U.S. residents, employees of Jack in the Box Inc. or franchise operators, and must not be fully reimbursed for tuition by any other source. Additionally, applicants should not already be enrolled at the University of Phoenix by the scholarship award date, must meet the university's admission requirements, and cannot be employees or family members of employees of Apollo Education Group, Inc. or its subsidiaries. A complete application along with supporting documents such as essays and a letter of recommendation must be submitted by a specified deadline. The selection process, managed by the Jack in the Box Foundation, involves a committee from both the foundation and the University of Phoenix. This process underscores a commitment to non-discrimination and bases selection on the overall merit of the application, the quality of the essays, and a letter of recommendation, all aimed at identifying individuals who demonstrate a strong desire for educational advancement and leadership development, thereby contributing positively to their communities.

QuestionAnswer
Form NameJack Box Scholarship
Form Length11 pages
Fillable?No
Fillable fields0
Avg. time to fill out2 min 45 sec
Other namesjack in the box scholarship form, jack in the box application pdf, jack in the box scholarship 2020, jack in the box scholarship

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JACK IN THE BOX

EMERGING LEADERS

SCHOLARSHIP

UNIVERSITY OF PHOENIX® JACK IN THE BOX EMERGING LEADERS SCHOLARSHIP

University of Phoenix is pleased to partner with the Jack in the Box Foundation to offer a scholarship program. Jack in the Box Inc. was founded in 1951. To support the communities in which their employees, franchisees and guests work and live, the Jack in the Box Foundation was created in 1998.

University of Phoenix understands the importance of making higher education highly accessible for students of all ages and backgrounds. As the largest private university in North America, we take very seriously our social responsibility to our students and the communities we serve. University of Phoenix is particularly adept at aiding non-traditional students complete their education by designing programs around their busy lives.

Through this scholarship program, four (4) full-tuition scholarships will be offered. Each scholarship will allow a prospective student the opportunity to complete an undergraduate or master’s degree program at

University of Phoenix. Recipients may choose to attend a University of Phoenix on-ground campus or may attend University of Phoenix online.

ELIGIBILTY CRITERIA

Applicants for the scholarship must demonstrate the following to be considered:

1.Applicants who reside in the United States must meet one of the following requirements: be a legal resident of the United States; have been granted permanent residency; have a valid visa that does not prohibit educational studies; have been granted temporary protected status along with approved Notice of Action issued by Citizen Immigration Services and verified through CIS Form g-845; or have been granted asylum along with the approved Notice of Action issued by the Citizen Immigration Services.

2.Applicants must be an employee of Jack in the Box Inc. or an employee of a Jack in the Box Franchise Operator.

3.Applicants, once enrolled, must not receive a total of 100% tuition reimbursement from any

source(s) including but not limited to: corporate reimbursement, other scholarships and/or private grants with the exception of Veteran’s Administration GI benefits or Veteran’s Administration

Vocational Rehabilitation Benefits and Title IV financial aid funding.

4.Applicants must not be currently enrolled nor in the process of enrolling at any University of Phoenix campus or in any online program at any time prior to the scholarship award date. Applicants who enroll after submitting an application or before the scholarship award date are not eligible to be a recipient of this scholarship.

5.Applicants must meet all admissions requirements of the University of Phoenix.

6.Applicants must not be an employee or family member of an employee of Apollo Group, Inc., University of Phoenix, Western International University, Institute for Professional Development or any other subsidiary of Apollo Group, Inc.

7.Applicants must submit a complete, signed application, together with all supporting documentation by the deadline date listed under the Selection Process section. The completion of the application form does not create an obligation to award a scholarship to applicant.

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8.Applicants must submit completed essays as described in the Essay section. High importance will be placed on the applicant’s desire to advance in their education, with an emphasis on furthering their careers, and their impact in the community in which they reside.

9.Applicants must submit one letter of recommendation from their supervisor as described in the Letter of Recommendation section.

SELECTION PROCESS

1.This scholarship opportunity is in partnership with the Jack in the Box Foundation, a non-profit organization, and the scholarship process is managed by a staff member at the Jack in the Box Foundation. The process includes, but is not limited to, application creation, scholarship promotion, selection committee formation and recipient list finalization. The application and any additional information submitted by eligible applicants will be subject to the Jack in the Box Foundation privacy and confidentiality policies, if any.

2.The recipient of this scholarship will be selected by the scholarship selection committee consisting of representatives from University of Phoenix and/or the Jack in the Box Foundation. Non-staff members may assist in the selection committee process.

3.It is the applicant’s responsibility to submit a complete and signed application along with all the supporting documentation, which must be received on or before the deadline specified below. The scholarship selection committee accepts no responsibility for incomplete applications, applications not in proper form, lost applications, or any other submission in exception to the above instructions.

4.The scholarship award will be based on the committee’s scores of the overall quality of the application and the scholarship essay(s). The higher the average score, the higher the probability of selection.

5.Scholarship selection shall be made without regard to age, race, color, national origin, sex, sexual orientation or disability.

6.The decision of the scholarship selection committee is final and not subject to a review process.

Deadline:

A complete application and supporting documentation must be received on or before July 31, 2012. Applications received after the designated deadline will not be considered. No exceptions.

Award Date:

The scholarship committee will determine the recipients of the scholarship by the award date of September 13, 2012. You will be notified via email by award date regarding the status of the scholarship. You will receive a notification email regardless if you were selected as a recipient or not.

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EMERGING LEADERS

SCHOLARSHIP

SUBMISSION INSTRUCTIONS

All materials must be mailed to the following address and received on or before the deadline of July 31, 2012.

University of Phoenix

Attn: Center for Scholarship Excellence CF-K901 4025 S. Riverpoint Parkway

Phoenix, AZ 85040

For any additional information, please contact Mary Craig by phone at 858.571.2346 or by email at mary.craig@jackinthebox.com

CHECK LIST

University of Phoenix Jack in the Box Emerging Leader Scholarship application completed

University of Phoenix Terms and Conditions signed

Apollo Group, Inc., Consent and Release signed

Essays

Letter of recommendation

Keep a copy of entire packet for your records

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APPLICANT INFORMATION

Full legal name of applicant: ___________________________________________________________________

Street address: ______________________________________________________________________________

City: _______________________________________ State: ______________ Zip: ________________________

Daytime phone number: ______________________________ Evening: ________________________________

Email address: _______________________________________________________________________________

SCHOOL INFORMATION/EDUCATIONAL PLANS

Highest level of school completed:

 

High school diploma/GED

 Associate’s degree

 Bachelor’s degree

 Master’s degree

Degree program of interest at University of Phoenix:

 Associate’s degree

 Bachelor’s degree

Master’s degree

Field of interest: _____________________________________________________________________

Current standing (as of the date of this application):

Not enrolled

High school senior (graduated by award date)

Undergraduate student

Graduate student

EMPLOYMENT INFORMATION

 

Date joined organization:

 

Current position:

 

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LEADERSHIP ABILITIES

Please list examples of situations in which you have demonstrated leadership abilities. (Examples can be from work assignments or outside activities including volunteer work.) Be specific about the situations, the skills you used, and the results.

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

SUPERVISOR’S LETTER OF RECOMMENDATION

One letter of recommendation must be included with the completed application. The letter must be written by your current supervisor. The letter should be written on a separate sheet of paper (preferably letterhead) and be included in the submitted application packet.

Each recommender’s letter should include the following (500 words maximum):

1.How long have you known the applicant and in what capacity?

2.Would you rate the applicant’s job performance as “effective” or higher?

3.What skills or abilities does the applicant have that will support him/her in completing a degree?

4.What other information about the applicant should be taken into consideration?

ESSAY

Compose three essays in response to the questions below. Each essay should be labeled accordingly (e.g. Essay 1 or Educational Goals). Your responses should be in paragraph format and adhere to the maximum word requirements indicated. Place your first and last name at the top of each page.

ESSAY 1: Educational Goals (300 word maximum)

What degree program are you interested in pursuing at University of Phoenix? How will a University of Phoenix education help you reach your professional and/or personal goals?

ESSAY 2: Leadership Skills (300 word maximum)

If you had the authority to influence Jack in the Box through your leadership skills, what specific change(s) would you make?

ESSAY 3: Personal Reflection (300 word maximum)

What attributes, qualities, or skills do you demonstrate that make you a good leader? Why are you a good candidate to receive this award?

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UNIVERSITY OF PHOENIX: TERMS & CONDITIONS

By applying for a University of Phoenix scholarship and/or accepting the scholarship award, the applicant and/or recipient agrees to the following terms and conditions. Failure to abide by any of the following terms and conditions shall result in either disqualification of the scholarship award or termination of the scholarship award.

1.All application submissions shall become the property of Apollo Group, Inc. as the parent company of the University of Phoenix, a wholly owned subsidiary, regardless if applicant is awarded the scholarship. In addition, applicant agrees to execute an Apollo Group, Inc. Consent and Release Form and further agrees that Apollo Group, Inc. and its subsidiaries may release the application and the information contained therein to its agents, contractors and related third parties for the purposes set forth below.

Upon the submission of the application by applicant or the award of the scholarship and applicant’s acceptance,

Apollo Group, Inc. including its subsidiaries as well as its agents, and others working for it on its behalf or at its

direction and their respective licensees, successors, and assigns shall have the right to use and republish the submitted application or any of its content; it may reference and acknowledge applicant’s/recipient’s name and authorship of the application; and may use recipient's name, image and likeness, for any purpose relating to the scholarship, including but not limited to, any promotional materials, internal sites, www.phoenix.edu, external company sites, press releases, and social media.

2.Scholarship award is a non-cash credit to recipient’s University of Phoenix account in the amount stated by the scholarship. No check or other cash monies will be disbursed at any time. No exceptions.

The University treats this tuition scholarship in the form of a non-cash credit as non-taxable income. However, the Recipient is encouraged to seek independent counsel from a certified tax consultant as Recipient is responsible for all other costs, liabilities, and obligations including any applicable taxes from the award of this scholarship as Federal laws may change and laws vary from state to state. The University makes no representations with respect to the taxability of this award and the University may change its treatment of the scholarship for tax purposes in its sole discretion.

3.Scholarship will be applied to tuition and fees only, as specified on the scholarship application; education supplies and living expenses are not included.

4.Whether applicant/recipient is or is not currently an enrolled student, he/she is not receiving a total of 100%

tuition reimbursement from any source(s) including but not limited to: corporate reimbursement, other scholarships and/or private grants with the exception of Veteran’s Administration GI benefits or Veteran’s

Administration Vocational Rehabilitation Benefits and Title IV financial aid funding.

5.Applicant/recipient must meet all University of Phoenix admissions requirements for selected program and campus. Information regarding admissions is available in the University of Phoenix Academic Catalog. Scholarship may only be used toward degrees that are specified on the scholarship application; Doctoral degrees are not covered by the scholarship. No exceptions.

6.Recipient must complete all admission and enrollment requirements for his/her chosen degree program (degree program must be currently available) at University of Phoenix no later than thirty (30) days following the scholarship award date, unless otherwise approved in writing by the University of Phoenix Center for Scholarship Excellence officials in their sole discretion. Unless specifically stated in the application otherwise. Applicants who enroll during the scholarship process or before the award date are not eligible for the scholarship, and any such enrollment in violation of these scholarship terms and conditions will result in the termination of the scholarship award.

7.Recipient must be scheduled for his/her first class no later than sixty (60) days following the scholarship award date, unless otherwise approved in writing by the University of Phoenix Center for Scholarship Excellence officials in their sole discretion .

8.Recipient must have successfully completed his/her first class within one hundred eighty (180) days following the scholarship award date unless otherwise approved in writing by the University of Phoenix Center for Scholarship Excellence officials in their sole discretion.

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9.If recipient is receiving Title IV financial aid funding in addition to this scholarship, applicant must stay in attendance as a full time student with no more than a twenty-nine (29) day break and/or must qualify for a leave of absence in order to maintain his/her financial aid status. Recipient is required to abide by all state and federal financial aid policies and procedures and all University of Phoenix financial policies and procedures as set forth in the University of Phoenix Academic catalog, including remaining in good financial standing with the University of Phoenix.

10.Recipient who falls out of attendance for more than 365 days (1 year) will forfeit his/her scholarship which shall be immediately terminated.

11.Recipient must maintain the minimum grade point average for the selected degree program, make satisfactory progress towards completing selected degree program (satisfactory progress is measured as successfully completing a minimum of 16 credits during each 24 attempted credits), and complete the selected degree program within the maximum time frame allowed according to federal regulations (The maximum time frame allowed is based on the required number of credits for graduation from the degree program, less any transfer or assessed credits, times 150%).

12.Recipient may only fall into academic probation once and must raise his/her academic status within four (4) consecutive classes. Recipients who fall into academic probation two times and/or academic disqualification will be in violation of these scholarship terms and conditions.

13.Recipient acknowledges that one of the eligibility requirements to receive this scholarship is that Recipient must not be an employee of Apollo Group, Inc. or any of its affiliates, including University of Phoenix. If Recipient becomes an employee and/or intern of Apollo Group, Inc. or any of its affiliates prior to or during the term of the scholarship, Recipient will no longer be eligible for the scholarship and University of Phoenix will automatically terminate the scholarship.

14.Recipient agrees to complete his/her degree program in the time set forth in the University Of Phoenix Academic Catalog. Switching degree programs may result in a loss of credits which this scholarship will not cover. If recipient changes degree programs, which results in a loss of credits, the scholarship will cover up to six (6) credits that do not transfer to the new degree program. No exceptions will be provided by the University of Phoenix.

15.Should recipient drop, receive a W grade or otherwise fail to complete a course for which the scholarship or a portion of the scholarship has been used to pay the tuition, any refund due shall be only applied to recipient’s

University of Phoenix account as a non-cash credit. In no event will any cash refund be given at any time. No exceptions. Recipients are permitted only two (2) dropped courses or W grades per eight (8) consecutively successfully completed courses. If the recipient exceeds the drop course limit, recipient agrees that he/she will be financially responsible for the tuition fees and costs for the current dropped course in accordance with University of Phoenix policies as set forth in the University of Phoenix Academic Catalog. Recipient acknowledges that said scholarship award shall not pay tuition and fees for excess dropped courses. Recipient agrees that he/she will have to pay any outstanding tuition balance within seventy-five (75) days max and must pay prior to enrolling in any future courses in order to continue with this scholarship award.

16.Scholarship award will only be applied to one re-take course. A “re-take” of a course means scholarship recipient has completed the course to a point of earning a letter grade of AF and has been scheduled to repeat the same

course. If recipient wishes to re-take an additional course(s), recipient must pay the entire tuition and fee costs of the course in accordance with University of Phoenix’s financial policies as set forth in the University of Phoenix

Academic Catalog. No scholarship award will be given on a re-taken course in excess award of one (1).

17.During the term of the scholarship, Recipient shall notify University of Phoenix immediately if he/she is convicted of a crime, excluding traffic offenses. This scholarship may be terminated immediately in University of Phoenix’s sole discretion if Recipient is convicted of a crime during the term of the scholarship.

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18.Recipient acknowledges and agrees that he/she will not portray Apollo Group, Inc., University of Phoenix or any

affiliates in a negative, harmful, disparaging, offensive or otherwise inappropriate manner as determined in the University of Phoenix’s sole discretion. Nor will Recipient associate Apollo Group, Inc., University of Phoenix or any affiliates in any way with content related to tobacco, alcohol, illegal drugs or sexually explicit material or

engage in conduct that is immoral or illegal that results in a criminal conviction. Any violation of this provision as determined in University of Phoenix’s sole discretion shall be grounds for immediate termination of this scholarship.

19.Recipient will relinquish all unused portions of scholarship award should recipient fail to meet any of the above terms and conditions for any reason. Determinations of failure to meet the stated terms will be made by the University of Phoenix Center for Scholarship Excellence officials in their sole discretion. Any unused portion of the Scholarship will be returned to University of Phoenix and is non-transferable. This scholarship does not apply towards doctoral degree programs.

20.Recipient agrees to abide by the University of Phoenix student catalog, including, but not limited to, the Student Code of Conduct. Any violation of the University of Phoenix student catalog, including, but not limited to, the

Student Code of Conduct as determined by University of Phoenix in accordance with the polices set forth therein, may result in termination of this scholarship. Such determination shall be in University of Phoenix’s sole discretion. Recipient acknowledges and agrees that he/she shall have no right to appeal or contest the decision of University of Phoenix to terminate the scholarship as set forth herein.

21.These terms and conditions are in addition to any other terms and conditions set forth in any other part of this document. Any necessary determination or clarification as to the interpretation or to the application of a particular term shall be made by the University of Phoenix Center for Scholarship Excellence officials in their sole discretion. Furthermore, University of Phoenix reserves the right in its sole discretion to make any changes or modifications to the scholarship, including but not limited to, the criteria, the selection process, the deadline dates, and the terms and conditions.

22.Failure to comply with the terms and conditions of the scholarship will result in disqualification for the scholarship and/or termination of the scholarship award.

23.In the event that any provision of the terms and conditions of this scholarship shall be held void, voidable, or unenforceable, the remaining provisions shall remain in full force and effect.

24.APPLICANT/RECIPIENT HEREBY AGREES TO RELEASE THE UNIVERSITY OF PHOENIX, APOLLO

GROUP, INC. AND ITS AFFILIATES, AS WELL AS EACH OF THEIR OFFICER, AGENTS, EMPLOYEES, SHAREHOLDERS, SERVANTS, DIRECTORS (“THE RELEASED PARTIES”) , FROM DAMAGES, LOSSES

(INCLUDING, BUT NOT LIMITED TO, LOSS OF EARNINGS, LOSS OF PROFITS, LOSS OF BUSINESS, LOSS OF WAGES), COSTS, EXPENSES AND LIABILITIES OF EVERY KIND AND NATURE, WITHOUT LIMITATION, INCLUDING CLAIMS OF DAMAGES OR INJURY TO PERSONAL PROPERTY AND FURTHER AGREE TO RELEASE THE RELEASED PARTIES FROM ANY THIRD PARTY CLAIMS OF ANY KIND WHATSOEVER WHETHER KNOWN OR UNKNOWN, SUSPECTED OR UNSUSPECTED, AND WHETHER OR NOT CONCEALED OR HIDDEN, WHICH I MAY NOW HAVE OR MAY HEREINAFTER HAVE AGAINST THE RELEASED PARTIES RESULTING FROM, OR ARISING OUT OF OR IN CONNECTION WITH, DIRECTLY OR INDIRECTLY, FROM THE SCHOLARSHIP SELECTION PROCESS BY JACK IN THE BOX FOUNDATION.

25.APPLICANT/RECIPIENT HEREBY AGREES TO RELEASE JACK IN THE BOX FOUNDATION AND ITS

AFFILIATES, AS WELL AS EACH OF THEIR OFFICER, AGENTS, EMPLOYEES, SHAREHOLDERS,

SERVANTS, DIRECTORS (“THE RELEASED PARTIES”) , FROM DAMAGES, LOSSES (INCLUDING, BUT

NOT LIMITED TO, LOSS OF EARNINGS, LOSS OF PROFITS, LOSS OF BUSINESS, LOSS OF WAGES), COSTS, EXPENSES AND LIABILITIES OF EVERY KIND AND NATURE, WITHOUT LIMITATION, INCLUDING CLAIMS OF DAMAGES OR INJURY TO PERSONAL PROPERTY AND FURTHER AGREE TO RELEASE THE RELEASED PARTIES FROM ANY THIRD PARTY CLAIMS OF ANY KIND WHATSOEVER WHETHER KNOWN OR UNKNOWN, SUSPECTED OR UNSUSPECTED, AND WHETHER OR NOT CONCEALED OR HIDDEN, WHICH I MAY NOW HAVE OR MAY HEREINAFTER HAVE AGAINST THE RELEASED PARTIES RESULTING FROM, OR ARISING OUT OF OR IN CONNECTION WITH, DIRECTLY OR INDIRECTLY, FROM THE SCHOLARSHIP ADMINISTRATION BY THE UNIVERSITY OF PHOENIX.

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ACKNOWLEDGEMENT

1.I have read and agreed to the above terms and conditions of the Scholarship and I understand the nature of the Scholarship and the extent of my obligations.

2.I certify to the best of my knowledge and ability that the above statements made in the scholarship application are true and correct. I understand that any misrepresentation or omission of fact is cause for disqualification and my application will not be considered.

3.This scholarship application is subject to the policies and procedures set forth in the applicable University catalog. In the event of a conflict between the terms of the scholarship and the catalog, the terms of the scholarship will control.

4.This University of Phoenix Terms and Conditions form may be executed electronically or by mail. An electronic copy of the agreement will be valid and given full force and effect and considered an original and will be denied legal effect because it was executed electronically. Facsimiles are not permitted, no exceptions.

Printed name: _________________________________________________________________________________

Signature: _________________________________________________________________ Date: _____________

If signatory/applicant/recipient is under the age of 18, the Parent or Legal Guardian must also sign below. By signing below said Parent or Legal Guardian represents that he/she has the legal right to and does consent to the terms and conditions of this scholarship. Said Parent or Legal Guardian further certifies to the best of his/her ability that the information contained in the scholarship application are true and correct.

Printed signature of parent/guardian: ____________________________________________________________

Signature of parent/guardian_________________________________________________ Date: ______________

Address (if different from applicant): _____________________________________________________________

Daytime phone number: ________________________________ Evening: _______________________________

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APOLLO GROUP, INC., CONSENT AND RELEASE FORM

1.For valuable consideration, the sufficiency of which is hereby acknowledged, I hereby grant to Apollo Group, Inc.,

its subsidiaries, agents, and others working for it on its behalf or at its direction and their respective licensees, successors, and assigns (herein collectively called the “Licensed Parties”) the absolute right and permission to use, record, publish, broadcast, and copyright, in whole or in part, in all countries in the world, my voice, biographical information, endorsement/testimonial, picture and likeness, or any material based upon or derived there from, or to refrain from so doing, in any manner or media whatsoever, without geographical or other limitation, for any educational, advertising or promotional purpose.

2.I further agree that any such use, recording, publication, or broadcast of my voice, endorsement/testimonial, picture or likeness of me, and any material based upon or derived there from, in any manner or media, is owned by Licensed Parties. If I should receive any print, negative, or other copy, I shall not authorize its use by anyone else.

3.I represent and warrant that I own all intellectual property rights (including but not limited to copyright and trademark rights) in any picture(s) or material(s) that I submit to the Licensed Parties and that no other third party releases are necessary. In the event I submit a picture(s) or other material(s) owned by a third party to the Licensed Parties, I shall provide all necessary third-party releases to the Licensed Parties. Said third-party releases shall grant to the Licensed Parties all rights set forth in this agreement. The Licensed Parties shall have the right in its sole discretion to deny any publication of said picture or materials. Furthermore, I acknowledge that any picture or materials submitted are not guaranteed for use by the Licensed Parties.

4.I shall have no right of approval, no claim to additional compensation, and no claim (including without limitation, claims based upon invasion of privacy, defamation, or right of publicity) arising out of any use, alteration, distortion, or illusionary effect, or use in any composite form.

5.I agree that this release does not in any way conflict with any existing commitment on my part. I have not heretofore authorized (which authority is still in effect), nor will I authorize or permit without the Licensed Parties express written permission the use of my voice, biographical information, endorsement/testimonial, picture, or likeness in connection with the advertising or promotion of any other educational service if such authorization or permission is in conflict or inconsistent with the terms of this Consent and Release Form.

6.If I have given any endorsement/testimonial, it represents my current honest opinions, findings, or experience. To the extent that I suggest I have used the educational services of a particular entity, I have in fact so used them. To the extent that I suggest I express a preference over other similar educational services, I do in fact prefer them. I agree to immediately notify you of any change in my expressed views or preferences, or if I cease to be able to endorse.

7.I agree to defend and hold the Licensed Parties harmless from and against any and all claims, demands, suits,

losses, liabilities, judgments, costs, expenses (including without limitation court costs, litigation expenses, and reasonable attorneys’ fees), and causes of action of any kind against the Licensed Parties as a result of any material breach of any representation made herein in this Consent and Release Form and/or resulting from any intellectual property violation including but not limited to any copyright infringement or alleged copyright infringement regarding pictures and materials that I have provided to the Licensed Parties.

8.This Apollo Group, Inc. Consent and Release form may be executed electronically or by mail. An electronic copy of the agreement will be valid and given full force and effect and considered an original and will be denied legal effect because it was executed electronically. Facsimiles are not permitted, no exceptions.

Printed name: ________________________________________________________________________________

Signature: ______________________________________________ Date: ________________________________

Phone number: _______________________________________________________________________________

Address: _____________________________________________________________________________________

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