Theodore Roosevelt Scholars are required to update this form at the end of every semester.

Full Name*

E-mail Address*

Local Phone*

Cell

Local Address*

City*

State*

Zip Code*

Summer Phone

Summer E-mail Address

Summer Address

Summer City

Summer State

Summer Zip Code

Previous Major

New Major

Activity Transcript

Please turn in your signed co-curricular activity form to the TR Program office before finals week of each semester. 
Reminder: (You must attend three (3) co-curricular activities each semester to maintain your TR status.)

Please indicate any scheduling conflicts you have encountered that will cause you to take a TR course out of sequence.  When do you intend to meet this requirement?

What recommendations do you have for improving the Theodore Roosevelt Program?

Will you be continuing in the Theodore Roosevelt Program for the upcoming semester? * Yes No Undecided

If you are undecided or not continuing in the TR Program, please indicate below your reason.

Please add the names and addresses of friends and family who you think would like to receive copies of the RoughWriter.