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The Ron Rosselot, Plan for Life Scholarship
Age Under 18+ Submissions

The Ron Rosselot, Plan for Life Scholarship is accepting submissions NOW through Friday, May 12, 2021!

Candidates Name
Year in School
Guardian(s) Name(s)
Guardian(s)/Candidates Phone Number
Guardian(s) Email Address
Candidates DOB
Guardian(s) DBO
Upload Video

Guardianship Waiver of a Minor (under 18):

In order to publicize your son/daughters accomplishments related to the Ron Rosselot, Plan for Life Scholarship, we will need your authorization to post his/her picture and/or video submission to our website and social media.  

The privacy of your contact information will be kept strictly confidential and will not be sold, stored, or used for any other purpose. 

The Rosselot Financial Group is the proud sponsor of the Ron Rosselot, Plan for Life Scholarship.   

Be sure to visit our web page, like us on Facebook and follow us on Twitter.  

I do hereby give Rosselot Financial Group, CRNA Financial, and Interdependent Advisors and their assigns, licenses, and legal representatives the irrevocable right to use my (or my minor child’s) name, picture, photograph, portrait, image, or voice in all forms and media in all manners, including composite or purpose, and I waive any right to inspect or approve the finished product, including written copy, that may be created in connection therewith.  I also agree that this releases said firms and any and all representatives from any and all monetary obligation to me or any or all of my authorized representatives for use of video, films, photos, images and or voice and/or voice.  I am of full legal age. I have read this release and am fully familiar with contents.

Child's Name
Relationship to Child



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The Rosselot Financial Group 7426 Jager Court Cincinnati, OH 45230
The Rosselot Financial Group
7426 Jager Court Cincinnati, OH 45230 

Phone: (513) 232-6500
Phone: (513) 232-6500
Fax: (513) 624-3124

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