TR Update Form

*indicates required feild

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

Student Information

Full Name*
E-mail Address*
Local Phone*
Cell
Local Address*
City*
State*
Zip Code*

Summer Contact Information

Summer Phone Number
Summer E-mail Address
Summer Address
Summer City
Summer State
Summer Zip Code

If you changed your major this ast semester, please fill in the boxes below.

Previous Major
New Major

Activity Transcript

Please turn in your co-curricular activity summary 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.)

Student Organizations/Offices Held:
Special Awards/Recognition:

Scheduling & Program Info

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.

291 Campus Drive
Dickinson, North Dakota 58601
ph: (701) 483-2507
toll free: (800) 279-HAWK
dsu.hawk@dickinsonstate.edu

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