Step 1 of 8 - Parent #1

Name

This field is for validation purposes and should be left unchanged.

Parent #1

Name(Required)

First Last

Address(Required)

Street Address City State ZIP Code

Phone number(Required)

Email(Required)

Student Information

Name(Required)

First Middle Last

Date of Birth(Required)

Address(Required)

Street Address City State ZIP Code

Phone number

School Name(Required)

Grade(Required)

Teacher Name if known

Enroll in an Indiana529 Direct savings account. Please choose one of the following options.(Required)

My child has an Indiana529 Direct account. I will email a statement showing my child's name and 529 account number, with the first 2 digits to imagine-early@cfwabash.org.

I need help opening an Indiana529 Direct account. Please contact me. In the account number space below, indicate the best times for the Community Foundation to call or email.

I am not interested

Only the first two digits of my child's 11-digit 529 account number:

Do you wish to enter information for an additional student?(Required)

Yes

Student Information #2

Name(Required)

First Middle Last

Date of Birth(Required)

Address(Required)

Street Address City State ZIP Code

Home Phone

School Name(Required)

Grade(Required)

Teacher Name if known

Enroll in an Indiana529 Direct savings account. Please choose one of the following options.(Required)

My child has an Indiana529 Direct account. I will email a statement showing my child's name and 529 account number, with the first 2 digits to imagine-early@cfwabash.org.

I need help opening an Indiana529 Direct account. Please contact me. In the account number space below, indicate the best times for the Community Foundation to call or email.

I am not interested

Only the first two digits of my child's 11-digit 529 account number:

Do you wish to enter information for an additional student?(Required)

Yes

Student Information #3

Name(Required)

First Middle Last

Date of Birth(Required)

Address(Required)

Street Address City State ZIP Code

Home Phone

School Name(Required)

Grade(Required)

Teacher Name if known

Enroll in an Indiana529 Direct savings account. Please choose one of the following options.(Required)

My child has an Indiana529 Direct account. I will email a statement showing my child's name and 529 account number, with the first 2 digits to imagine-early@cfwabash.org.

I need help opening an Indiana529 Direct account. Please contact me. In the account number space below, indicate the best times for the Community Foundation to call or email.

I am not interested

Only the first two digits of my child's 11-digit 529 account number:

Do you wish to enter information for an additional student?(Required)

Yes

Student Information #4

Name(Required)

First Middle Last

Date of Birth(Required)

Address(Required)

Street Address City State ZIP Code

Home Phone

School Name(Required)

Grade(Required)

Teacher Name if known

Enroll in an Indiana529 Direct savings account. Please choose one of the following options.(Required)

My child has an Indiana529 Direct account. I will email a statement showing my child's name and 529 account number, with the first 2 digits to imagine-early@cfwabash.org.

I need help opening an Indiana529 Direct account. Please contact me. In the account number space below, indicate the best times for the Community Foundation to call or email.

I am not interested

Only the first two digits of my child's 11-digit 529 account number:

Do you wish to enter information for an additional student?(Required)

Yes

Student Information #5

Name(Required)

First Middle Last

Date of Birth(Required)

Address(Required)

Street Address City State ZIP Code

Home Phone

School Name(Required)

Grade(Required)

Teacher Name if known

Enroll in an Indiana529 Direct savings account. Please choose one of the following options.(Required)

My child has an Indiana529 Direct account. I will email a statement showing my child's name and 529 account number, with the first 2 digits to imagine-early@cfwabash.org.

I need help opening an Indiana529 Direct account. Please contact me. In the account number space below, indicate the best times for the Community Foundation to call or email.

I am not interested

Only the first two digits of my child's 11-digit 529 account number:

Imagine Early Participation Agreement

The Imagine Early Program, developed and administered by the Community Foundation of Wabash County, Inc. (Community Foundation) offers students in grade 4 through 12 the opportunity to earn scholarships and savings matches to help pay for college and career training after high school. For work accomplished in and out of school – setting goals, turning in assignments, learning about career and college options, volunteering, leading a club or team – students can earn up to $3,000 in scholarships and savings matches.

To earn Imagine Early scholarships and savings matches, parents must agree to participate in Imagine Early as follows:

Authorization for Release of Protected Educational Records

I authorize the Wabash County school where my child attends to disclose educational records regarding my child, as further described below, for the purpose of my child being eligible to apply for and receive scholarship funds through Imagine Early. The name of the person or class of persons authorized to receive the information are employees of the Community Foundation of Wabash County, 220 East Main St, North Manchester, IN 46962. The following protected educational records (collectively “Minor’s Data”) may be disclosed by my child’s school: All educational records of my child that establish my child has met the academic criteria to be eligible for a scholarship award through Imagine Early administered by the Community Foundation of Wabash County. I am authorizing this release relating to my child’s educational records to remain valid through the end of my child’s 12th grade school year. Further, I understand and agree that Minor’s Data may be used as part of research and evaluation within this initiative. The research staff will maintain my child’s confidentiality by not revealing his or her name, but merely the data collected itself. However, no information about my child will be disclosed to any entity, person, or company outside the research process.

I authorize the Community Foundation to receive a report of my child’s out of school activities uploaded by my 9th-12th grade child to the Foundation’s online portal, for the purpose of my child being eligible to apply for and receive scholarship funds through Imagine Early. Further, I understand and agree that this information may be used as part of research and evaluation within this initiative. The research staff will maintain my child’s confidentiality by not revealing his or her name, but merely the data collected itself. However, no information about my child will be disclosed to any entity, person, or company outside the research process.

Authorization for Release of Depictions and Works

I authorize the Community Foundation, Manchester Community Schools, Metropolitan School District of Wabash County, Wabash City Schools, St. Bernard Catholic School, Indiana529, State of Indiana, Indiana Education Savings Authority, and Ascensus Broker Dealer Services, Inc., including each of their respective affiliates, directors, officers, employees, contractors, representative and agents, (collectively, “Imagine Early Program Representatives”) to take photographs, video/audio/sound recordings and interviews (collectively, “Depictions”) of me and/or the minor child listed in this Imagine Early Participation Agreement for its lawful use in connection with the Imagine Early Program including use in any audio or visual work, marketing materials, print campaigns, posters, commercials, social media, internet sites or any other media (whether now known or hereafter devised) (collectively, “Works”). I hereby assign fully to the Imagine Early Program Representatives, all right, title and interest in and to all Depictions and Works, and accordingly grant the Imagine Early Program Representatives the right to reproduce, exhibit, display, broadcast and distribute the Works or Depictions, and all derivative works thereof. I further waive any right to inspect or approve the use of the Depictions or Works or rights to any royalties or other compensation arising from or related to the use of the Depictions or Works, in connection with the use of the Depictions of Works as described above. I hereby release and hold harmless Imagine Early Program Representatives from and against any and all losses, claims, penalties, demands, actions, causes of action, damages, complaints, or liability arising out of or related to the use of the Minor’s Data, Works, or Depictions of me and/or the minor child.

I acknowledge that, in order to receive the optional 529 enrollment bonus or the savings match, I must share 529 deposit activity with the Community Foundation for the semester in which the bonus or match is desired, by the last day of that semester. I understand that the Foundation destroys 529 deposit activity sent by the family at the end of each semester, and that the Foundation has no access whatsoever to the family-owned 529 account.

I certify that I am the parent or legal guardian of the minor child listed in the Imagine Early Participation Agreement. I have read the contents of this waiver and fully understand its contents, meaning and impact and sign it of my own free act and will.

I authorize the Community Foundation to use my and my child’s contact information to send information about Imagine Early. This communication includes keeping in contact with my child after high school graduation and up to age 22, to remind them of their Fund balance and to send instructions on how to request a grant from their Fund to pay for qualifying post-secondary educational expenses. I understand that I can unsubscribe or opt out of these communications at any time. I understand that, from time to time, the Imagine Early Program undergoes evaluation for the purpose of improving its effectiveness, and that I may be invited to participate in such evaluations by way of the contact information that I provide.

Revised 7.24.26

Parent or Guardian Electronic Signature(Required)

Date(Required)

Parent #1

Parent #2 (optional)

Student Information

Student Information #2

Student Information #3

Student Information #4

Student Information #5

Imagine Early Participation Agreement

Authorization for Release of Protected Educational Records

Authorization for Release of Depictions and Works