I certify that, to the best of my knowledge, the information contained in this application is true and accurate.
EDUCATIONAL INSTITUTION AUTHORIZATION AND RELEASE: I authorize all educational institutions where Student is or has been enrolled to disclose to McLean County Farm Bureau ("MCFB") any information in their possession about Student’s education and academic record. I release those educational institutions from any liability or claim relating to the disclosure of such information to MCFB.
This statement will serve as notice that if the student withdraws or drops out of school, the monies from MCFB will be payable back to the MCFB.
By submitting my electronic signature, I agree to the Terms outlined in the Agreement Statement.