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HomeMy WebLinkAboutPR 24019: EDC AND LAMAR STATED COLLEGE PORT ARTHUR, TUITION REIMBURSEMENT FOR 10 PORT ARTHUR RESIDENT HIGH SCHOOL GRADUATES , 2 YEAR ASSOICATE DEGREE PROGRAM .1114, poimicAtatiuR INTEROFFICE MEMORANDUM Date: December 13, 2024 To: The Honorable Mayor and City Council Ronald Burton, CPM I City Manager From: Terry Stokes, PAEDC Chief Executive Officer RE: P.R. 24019 I A resolution approving a Training Agreement between the Port Arthur Economic Development Corporation and Lamar State College Port Arthur for Tuition Reimbursement for ten(10) Port Arthur Resident High School Graduates attending a 2-Year Associate Degree Program. Introduction: The intent of this Agenda Item is to seek the City Council's approval for entering into an agreement with Lamar State College Port Arthur and funding ten(10) Port Arthur resident high school graduates attending a 2-year associate degree program. Background: This program has been successful since its inception in 2019. The Board of Directors of the Port Arthur Economic Development Corporation has found that supporting students in Port Arthur through a 2-year associate degree program helps to decrease the unemployment rate in the City of Port Arthur. The PAEDC Training Program will help ten (10) graduating Port Arthur residents obtain a 2- year associate degree in a field that is in high demand or considered a primary job through the Texas Government Code for Economic Development. The PAEDC will pay up to $9,000.00 per student, not to exceed $90,000.00. Budget Impact: The budget impact of this item is $90,000, funds available in PAEDC FY 24-25 Account No. 120-80-625-5475-00-00-000 - (Job Training Programs). Recommendation: It is recommended that the City Council of the City of Port Arthur authorize the Port Arthur EDC to move forward with entering into a training agreement with Lamar State College Port Arthur to educate ten(10) Port Arthur Residents at$9,000.00 per student who wish to obtain a 2- year associates degree through Lamar State College Port Arthur in an amount not to exceed $90,000.00. Fir P.R. No.24019 12/13/2024 SDG RESOLUTION NO. A RESOLUTION APPROVING A TRAINING AGREEMENT BETWEEN THE PORT ARTHUR ECONOMIC DEVELOPMENT CORPORATION AND LAMAR STATE COLLEGE PORT ARTHUR FOR TUITION REIMBURSEMENT FOR TEN (10) PORT ARTHUR RESIDENT HIGH SCHOOL GRADUATES ATTENDING A 2- YEAR ASSOCIATE DEGREE PROGRAM NOT TO EXCEED $90,000; FUNDS AVAILABLE IN PAEDC FY 24-25 ACCOUNT NO. 120-80-625-5475-00-00-000 (JOB TRAINING PROGRAMS) WHEREAS, the Board of Directors of the Port Arthur Economic Development Corporation ("PAEDC") has found that supporting students in Port Arthur through 2-year associate degree programs helps to decrease the unemployment rate in the City of Port Arthur; and WHEREAS, Lamar State College Port Arthur ("LSCPA") offers numerous 2-year associate degree programs; and WHEREAS, the PAEDC Board of Directors has created program guidelines attached hereto as Exhibit "A" that establishes criteria for recipient award qualifications and establishes which degree programs are eligible; and WHEREAS, according to the guidelines, the PAEDC Board of Directors will determine eligibility of award recipients,and LSCPA will invoice PAEDC for cost associated with the degree program, and PAEDC will make payment; and WHEREAS, PAEDC will allocate a total of$90,000 for eligible students or $9,000 each for a total of Ten(10) students; and WHEREAS, House Bill 1967 amends the Texas Local Government Code by adding §501.163 which authorizes expenditures for pre-employment training by PAEDC; and P.R.No.24019 12/13/2024 SDG ror WHEREAS, at their November 4, 2024, regular Board meeting, the PAEDC Board of Directors approved a Training Agreement with LSCPA attached hereto as Exhibit "B" for tuition reimbursement for Ten(10)Port Arthur resident high school graduates attending a 2-year associate degree program in an amount not to exceed $90,000. NOW,THEREFORE,BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF PORT ARTHUR, TEXAS: Section 1. That the facts and opinions in the preamble are true and correct. Section 2. That the City Council approves PAEDC entering into a Training Agreement with Lamar State College Port Arthur for tuition reimbursement for Ten(10) Port Arthur resident high school graduates attending a 2-year associate degree program in an amount not to exceed $90,000, in substantially the same form as attached hereto as Exhibit "B". Section 3. That a copy of the caption of this Resolution be spread upon the Minutes of the City Council. READ,ADOPTED AND APPROVED on this day of A.D., 2025, at a Meeting of the City Council of the City of Port Arthur, Texas, by the following vote: AYES: Mayor Councilmembers NOES: P.R.No.24019 12/13/2024 SDG Page 2 Thurman Bartie, Mayor ATTEST: Sherri Bellard,City Secretary APPROVED: 17i4L' Terry Stokes,PAEDC CEO APPROVED AS TO FORM: Charlie Zech, PAEDC Attorney Denton Navarro Rodriguez Bernal Santee & Zech,P.C. Stan Springerley, Senior Associate Attorney APPROVED AS TO FORM: Roxann Pais Cotroneo , City Attorney APPROVED AS TO AVAILABILITY OF FUNDS: bdtwl t i4 6"'(/( 1/ Lynda Boswell,Finance Director P.R.No.24019 12/13/2024 SDG Page 3 rr E h • b • t A P.R.No.24019 12/13/2024 SDG Port Arthur Economic Development Corporation LSCPA Scholarship The Economic Development Corporation of Port Arthur(PAEDC) offers a tuition fund for up to ten (10) high school seniors graduating this year and incoming high school seniors, who intend to enroll at Lamar State College Port Arthur(LSCPA). To be eligible, applicants need to have a minimum Grade Point Average (GPA)of 2.5 on a 4.00 scale and must aim to obtain an associate degree in any of the following programs available at LSCPA: -Drafting - Heating, Ventilation, & Air Conditioning - Instrumentation Technology -Medical Coding Specialist - Medical Office Administration -Process Technology - Surgical Technology -Nursing Scholarship requirements: 1. To be eligible for the PAEDC Scholarship, applicants must meet the following criteria: I.Eligibility Criteria: - Must be a graduating high school senior or junior promoting to a high school senior. - Must be a resident of Port Arthur. - Must be planning to continue education in a college program at Lamar State College Port Arthur(LSCPA). - Must have a minimum cumulative GPA of 2.5. 2. Scholarship Amount: - The scholarship award will not exceed $9,000 and will be distributed in up to eight(8) segments over the course of a two-year college program. - Distributions will be limited to four per academic year(Spring, Fall, Summer 1 & 2). 3. Distribution Conditions: - The first distribution will be granted upon receipt of a letter of acceptance from LSCPA and proof of full-time enrollment. - Subsequent distributions will be contingent upon the student maintaining full-time enrollment per semester and achieving a minimum cumulative GPA of 2.5. - Grades for each semester and full-time enrollment for the next semester must be submitted to PAEDC as proof of eligibility prior to the next disbursement of funds. 3. Ineligibility and Fund Management: -Any scholarship funds not distributed due to ineligibility will remain the property of PAEDC. - If a recipient leaves LSCPA before completing the program, any remaining scholarship funds will be forfeited. Applicants are encouraged to review these requirements carefully and ensure all conditions are met before applying for the scholarship. We wish you the best of luck in your educational pursuits! 2. Scholarship applications should be submitted in the spring of each year. Specific time windows when applications are being accepted will be communicated to the school's guidance counselor and on PAEDC's website. PAEDC will additionally run an announcement of the scholarship application period on the city's television broadcast, Channel 4. Parents are urged to encourage their children to apply for the scholarship. 3. If scheduling allows,the recipients will be announced at their high school's Awards Banquet, Graduation, or equivalent. 4. This scholarship can be used for tuition, books, laboratory fees,and other academic costs and miscellaneous fees. 5. Scholarship checks will be sent directly to the LSCPA Financial Aid Offices. 6. If a scholarship winner must delay their education for any reason,the recipient must contact the PAEDC in writing as soon as possible. The scholarship will be held up to one year from the date PAEDC has been notified of the delay. After that time, the PAEDC will have the discretion to hold or withdraw the scholarship award as they see fit. All Port Arthur graduating seniors and incoming seniors who are interested can obtain applications from their high school counselors or the PAEDC. The deadline for submitting applications is May 1,2025. For additional information contact: The Port Arthur Economic Development Corporation (409) 963-0579 INSTRUCTIONS FOR SUBMITTING THE SCHOLARSHIP APPLICATION 1. The entire application must be completed for consideration by the Tuition Fund Committee. 2. Type or neatly print all information. 3. Attach a one-page essay described in Section III of this application. 4. Sign and date the last page. 5. Have the guidance counselor sign and date the last page,verifying TSI/SAT scores, class rank,and cumulative high school grade point average 6. Provide high school transcript. 7. Hand deliver or mail to the Port Arthur Economic Development Corporation,Attn: Shawn Granger,501 Procter St., Ste. 100,Port Arthur,TX 77640. 8. All applicants will be reviewed,and the finalists will be called for an interview. Port Arthur Economic Development Corporation Lamar State College Port Arthur Scholarship Application Section I: Personal Information NAME (LAST,FIRST AND MIDDLE INITIAL) PERMANENT MAILING ADDRESS (STREET,CITY, STATE,ZIP CODE) HOME PHONE NUMBER (INCLUDING AREA CODE) EMAIL ADDRESS YEAR OF GRADUATION FROM HIGH SCHOOL NAME OF FATHER/GUARDIAN (LAST,FIRST AND MIDDLE INITIAL) NAME OF MOTHER/GUARDIAN (LAST,FIRST AND MIDDLE INITIAL) INCOME RANGE OF ❑ LESS THAN $50,000/YEAR ❑ FAMILY $50,000/YEAR OR MORE NUMBER OF COLLEGE STUDENTS IN THE FAMILY THE NEXT SCHOOL YEAR(NOT INCLUDING SELF) HAVE YOU COMPLETED YOUR APPLICATION TO LAMAR STATE COLLEGE PORT ARTHUR HAVE YOU BEEN ACCEPTED TO LAMAR STATE COLLEGE PORT ARTHUR OTHER INSTITUTIONS WHERE YOU HAVE APPLIED AND/OR BEEN ACCEPTED INTENDED PROFESSION/CAREER SAT (VERBAL/MATH)/TSI SCORES NAME OF HIGH SCHOOL CUMULATIVE HIGH SCHOOL RANK(STATE TOTAL HIGH SCHOOL CLASS SIZE) CUMULATIVE HIGH SCHOOL GRADE POINT AVERAGE Section II: Activities NAME OF SCHOOL YEAR MAJOR OFFICE MOST EXTRACURRICU IN WHICH YOU HELD/ SIGNIFICANT LAR ACTIVITY PARTICIPATED HONORS CONTRIBUTION SPONSORED BY IN THIS RECEIVED HIGH SCHOOL ACTIVITY Examples:Academic Clubs, Musical Groups, Sport Teams, etc. WORK EXPERIENCE EMPLOYER POSITION SPECIFY IF AVERAGE DURING HOURS SCHOOL YEAR PER WEEK OR SUMMER COMMUNITY ACTIVITY/VOLUNTEER WORK ORGANIZATION ACTIVITY SPECIFY IF AVERAGE DURING HOURS SCHOOL YEAR PER WEEK OR SUMMER NAME ANY SCHOOL YEAR DESCRIBE WHAT YOU DID TO OTHER SPECIAL RECEIVED EARN RECOGNITION RECOGNITION, ACADEMIC HONOR,OR SPECIAL ACHIEVEMENT YOU HAVE RECEIVED Section III: Essay Attach an essay to this application. The document should be approximately 500 words, double- spaced in 10 to 12 point font. (Applications submitted without an essay will not be considered) Describe why you deserve the PAEDC Scholarship. Discuss why you chose your field of study, what your objectives are, and how a higher education will help you to further realize your goals. The foregoing facts and the attached essay are true to the best of my knowledge. Student Signature Date Guidance Counselor Signature Date Exhibit B TRAINING AGREEMENT BETWEEN CITY OF PORT ARTHUR SECTION 4A ECONOMIC DEVELOPMENT CORPORATION AND LAMAR STATE COLLEGE PORT ARTHUR RECITALS WHEREAS,The Port Arthur Economic Development Corporation("PAEDC")Board has found that supporting students in Port Arthur through two(2)year associate degree programs helps to decrease the unemployment rate in the City of Port Arthur. WHEREAS, Lamar State College Port Arthur ("LSCPA") offers numerous two year associates degree programs (the "Program"). WHEREAS,PAEDC will establish a committee made up of PAEDC representatives and LSCPA representatives to create program guidelines which will establish criteria for recipient award qualifications and establish which degree programs are eligible. WHEREAS, after the Committee determines eligibility, LSCPA will invoice PAEDC for cost associated with the degree program and PAEDC will make payment. WHEREAS, PAEDC will allocate a total of$90,000 for eligible students or $9,000 each for a total of ten (10) students. NOW THEREFORE, IN CONSIDERATION of the recitals set forth above which are incorporated in this Agreement as fully set forth below and in consideration of the additional and mutual promises,covenants,conditions and agreements set forth in this Agreement and other good and valuable consideration, the sufficiency of which is hereby acknowledged by each party, LSCPA and the PAEDC agree as follows: AGREEMENT DATES AGREEMENT START DATE 1. This Agreement ("Agreement") is entered into with an effective date of AGREEMENT END DATE 2. This Agreement expires on PARTIES 3. PAEDC located at 501 Procter, Port Arthur, Texas 77640, is a not-for-profit corporation. It is duly authorized to do business in the State of Texas under Section 4A, Article 5190.6 V.T.C.A. (the Development Corporation Act of 1979), its Board of Directors has approved this Agreement, and this Agreement has been duly authorized by Resolution of the City Council of the City of Port Arthur. As so authorized and as provided by the PAEDC bylaws,the President and Secretary of the PAEDC Board have the authority to execute this Agreement. 4. Lamar State College Port Arthur, 1500 Procter Street, Port Arthur, Texas 77640. CONDITIONS PRECEDENT 5. This Agreement has no legal consequences unless and until both the Board of Directors of the PAEDC and the City of Port Arthur City Council approve this Agreement in its final form. PROMISED PERFORMANCE 6. The parties agree to perform as follows: (a) PERFORMANCE BY LSCPA (1) Funding in the amount of $90,000 is allocated to LSCPA subject to the approval of the City. LSCPA will provide the following services: a. Work with PAEDC to identify eligible students pursuant to the Program Guidelines attached hereto as Exhibit "A". b. Provide invoices to PAEDC for cost associated with degree program. c. Provide PAEDC with reports on the students. (b) PERFORMANCE BY PAEDC (1) PAEDC shall submit payment in an amount not to exceed $9,000 per student after receipt of an invoice. (2) PAEDC shall allocate a total of$90,000 to the Program. PAEDC'S CONDITIONAL OBLIGATIONS AND LIMITED LIABILITY 7. The PAEDC or the City, at its sole option, may terminate this Agreement for nonperformance or failure to comply with the terms of this contract. In the event of such termination by the PAEDC, the PAEDC may, at its sole option, immediately cease all further funding, if any, required by this Agreement and the PAEDC shall not be liable to LSCPA or to any third parties for failure to make payments to LSCPA under the terms and conditions of this Agreement. 8. The PAEDC's sole liability/obligation shall be to LSCPA and shall be limited to the funding for the Programs detailed in this Agreement. The PAEDC shall not be liable, in contract or otherwise, for any expense, expenditure or cost incurred by or on behalf of LSCPA related to the Programs except as set forth in this Agreement. RECORDS/INSPECTION/PAEDC AUDIT 9. All records pertinent to this Agreement shall be retained by LSCPA. 10. Upon written request, LSCPA shall provide PAEDC with all reports reasonably necessary for PAEDC compliance with the Development Corporation Act of 1979(Article 5190.6 V.T.C.A.)and Chapter 504, Local Government Code. CHANGES AND AMENDMENTS 11. Any alterations, additions, or deletions to the terms of this Agreement shall be by amendment in writing and executed by all parties to this Agreement and approved by the PAEDC. 12. Any alterations, additions, or deletions to the terms of this Agreement which are required by changes in Federal, state or local law are automatically incorporated into this Agreement without written amendment hereto, and shall become effective on the date designated by such law or regulation. DEFAULT/TERMINATION 13. In the event of default of any of the obligations of LSCPA detailed herein, the PAEDC may, at its sole and exclusive option,withhold and/or disallow further PAEDC payments or incentives to LSCPA. 14. In addition to the foregoing, the PAEDC and LSCPA agree that this Agreement may be terminated at any time when both parties agree, in writing, to the terms and conditions of any such voluntary termination. ORAL AND WRITTEN AGREEMENTS/PRIOR AGREEMENTS 15. All oral and written agreements between the parties to this Agreement relating to the subject matter of this Agreement that were made prior to the execution of this Agreement have been reduced to writing and are contained in this Agreement. VENUE 16. For purposes of litigation that may accrue under this Agreement, venue shall be Jefferson County, Texas, where substantially all the performance will occur. ADDRESS OF NOTICE AND COMMUNICATIONS City of Port Arthur 4A Economic Development Corporation 501 Procter Port Arthur, Texas 77640 ATTN: Terry Stokes , Chief Executive Officer Lamar State College Port Arthur 1500 Procter Street Port Arthur, Texas 77640 ATTN: Dr. Betty J. Reynard, President CAPTIONS 17. This Agreement has been supplied with captions to serve only as a guide to the contents. The caption does not control the meaning of any paragraph or in any way determine its interpretation or application. ATTORNEY APPROVALS APPROVED AS TO FORM: Charlie Zech, Legal Counsel for PAEDC VERIFIED AS CONSISTENT WITH CITY COUNSEL RESOLUTION: Resolution Number: City Attorney AGREEMENT EXECUTION PORT ARTHUR ECONOMIC DEVELOPMENT CORPORATION SIGNED AND AGREED TO on the day of , 2025. By: By: PAEDC CEO Secretary Witness Witness LAMAR STATE COLLEGE PORT ARTHUR SIGNED AND AGREED TO on the day of , 2025. By: Witness Exhibit A Port Arthur Economic Development Corporation LSCPA Scholarship The Economic Development Corporation of Port Arthur(PAEDC) offers a tuition fund for up to ten(10)high school seniors graduating this year and incoming high school seniors, who intend to enroll at Lamar State College Port Arthur(LSCPA). To be eligible, applicants need to have a minimum Grade Point Average (GPA) of 2.5 on a 4.00 scale and must aim to obtain an associate degree in any of the following programs available at LSCPA: - Drafting -Heating, Ventilation, & Air Conditioning - Instrumentation Technology - Medical Coding Specialist - Medical Office Administration -Process Technology - Surgical Technology -Nursing Scholarship requirements: 7. To be eligible for the PAEDC Scholarship. applicants must meet the following criteria: 1.Eligibility Criteria: - Must be a graduating high school senior or junior promoting to a high school senior. - Must be a resident of Port Arthur. - Must be planning to continue education in a college program at Lamar State College Port Arthur(LSCPA). -Must have a minimum cumulative GPA of 2.5. 2. Scholarship Amount: -The scholarship award will not exceed $9,000 and will be distributed in up to eight(8) segments over the course of a two-year college program. -Distributions will be limited to four per academic year(Spring, Fall, Summer 1 & 2). 3. Distribution Conditions: - The first distribution will be granted upon receipt of a letter of acceptance from LSCPA and proof of full-time enrollment. - Subsequent distributions will be contingent upon the student maintaining full-time enrollment per semester and achieving a minimum cumulative GPA of 2.5. - Grades for each semester and full-time enrollment for the next semester must be submitted to PAEDC as proof of eligibility prior to the next disbursement of funds. 3. Ineligibility and Fund Management: -Any scholarship funds not distributed due to ineligibility will remain the property of PAEDC. - If a recipient leaves LSCPA before completing the program, any remaining scholarship funds will be forfeited. Applicants are encouraged to review these requirements carefully and ensure all conditions are met before applying for the scholarship. We wish you the best of luck in your educational pursuits! 8. Scholarship applications should be submitted in the spring of each year. Specific time windows when applications are being accepted will be communicated to the school's guidance counselor and on PAEDC's website. PAEDC will additionally run an announcement of the scholarship application period on the city's television broadcast, Channel 4. Parents are urged to encourage their children to apply for the scholarship. 9. If scheduling allows, the recipients will be announced at their high school's Awards Banquet, Graduation, or equivalent. 10. This scholarship can be used for tuition, books, laboratory fees,and other academic costs and miscellaneous fees. 11. Scholarship checks will be sent directly to the LSCPA Financial Aid Offices. 12. If a scholarship winner must delay their education for any reason, the recipient must contact the PAEDC in writing as soon as possible. The scholarship will be held up to one year from the date PAEDC has been notified of the delay. After that time, the PAEDC will have the discretion to hold or withdraw the scholarship award as they see fit. All Port Arthur graduating seniors and incoming seniors who are interested can obtain applications from their high school counselors or the PAEDC. The deadline for submitting applications is May 1,2025. For additional information contact: The Port Arthur Economic Development Corporation (409) 963-0579 INSTRUCTIONS FOR SUBMITTING THE SCHOLARSHIP APPLICATION 9. The entire application must be completed for consideration by the Tuition Fund Committee. 10. Type or neatly print all information. 11. Attach a one-page essay described in Section III of this application. 12. Sign and date the last page. 13. Have the guidance counselor sign and date the last page,verifying TSI/SAT scores, class rank,and cumulative high school grade point average 14. Provide high school transcript. 15. Hand deliver or mail to the Port Arthur Economic Development Corporation,Attn: Shawn Granger,501 Procter St., Ste. 100,Port Arthur, TX 77640. 16. All applicants will be reviewed, and the finalists will be called for an interview. Port Arthur Economic Development Corporation Lamar State College Port Arthur Scholarship Application Section I: Personal Information NAME (LAST,FIRST AND MIDDLE INITIAL) PERMANENT MAILING ADDRESS (STREET,CITY, STATE,ZIP CODE) HOME PHONE NUMBER (INCLUDING AREA CODE) EMAIL ADDRESS YEAR OF GRADUATION FROM HIGH SCHOOL NAME OF FATHER/GUARDIAN (LAST,FIRST AND MIDDLE INITIAL) NAME OF MOTHER/GUARDIAN (LAST,FIRST AND MIDDLE INITIAL) INCOME RANGE OF ❑ LESS THAN $50,000/YEAR ❑ FAMILY $50,000/YEAR OR MORE NUMBER OF COLLEGE STUDENTS IN THE FAMILY THE NEXT SCHOOL YEAR(NOT INCLUDING SELF) HAVE YOU COMPLETED YOUR APPLICATION TO LAMAR STATE COLLEGE PORT ARTHUR HAVE YOU BEEN ACCEPTED TO LAMAR STATE COLLEGE PORT ARTHUR OTHER INSTITUTIONS WHERE YOU HAVE APPLIED AND/OR BEEN ACCEPTED INTENDED PROFESSION/CAREER SAT (VERBAL/MATH)/TSI SCORES NAME OF HIGH SCHOOL CUMULATIVE HIGH SCHOOL RANK(STATE TOTAL HIGH SCHOOL CLASS SIZE) CUMULATIVE HIGH SCHOOL GRADE POINT AVERAGE Section II: Activities NAME OF SCHOOL YEAR MAJOR OFFICE MOST EXTRACURRICU IN WHICH YOU HELD/ SIGNIFICANT LAR ACTIVITY PARTICIPATED HONORS CONTRIBUTION SPONSORED BY IN THIS RECEIVED HIGH SCHOOL ACTIVITY Examples:Academic Clubs, Musical Groups, Sport Teams, etc. WORK EXPERIENCE EMPLOYER POSITION SPECIFY IF AVERAGE HOURS DURING SCHOOL PER WEEK YEAR OR SUMMER COMMUNITY ACTIVITY/VOLUNTEER WORK ORGANIZATION ACTIVITY SPECIFY IF AVERAGE DURING HOURS SCHOOL YEAR PER WEEK OR SUMMER NAME ANY SCHOOL YEAR DESCRIBE WHAT YOU DID TO OTHER SPECIAL RECEIVED EARN RECOGNITION RECOGNITION, ACADEMIC HONOR,OR SPECIAL ACHIEVEMENT YOU HAVE RECEIVED Section III: Essay Attach an essay to this application. The document should be approximately 500 words, double- spaced in 10 to 12 point font. (Applications submitted without an essay will not be considered) Describe why you deserve the PAEDC Scholarship. Discuss why you chose your field of study, what your objectives are, and how a higher education will help you to further realize your goals. The foregoing facts and the attached essay are true to the best of my knowledge. Student Signature Date Guidance Counselor Signature Date