Academic & Program Change Notification Form

This form is for Tillman Scholars to notify us of changes that may impact their scholarship status—such as academic delays, field of study changes, or missed reporting.

Submissions will be reviewed by the Programs and Scholarships teams in alignment with scholar policies.

In some cases, failure to communicate changes may result in probation or termination from the program. We’ll follow up with you directly after review.

First Name

Last Name

Email

University

Field of Study (when you were originally selected)

Are you changing your field of study?

YesNo

If yes, what is your new field of study?

Original Graduation Date

Updated Graduation Date (if applicable)

Brief description of your situation. (What's going on, and what are you requesting)?

How does this change or situation relate to your long-term goals and impact?

Supporting Documentation (if applicable) ((ex: advisor letter, medical note, updated transcript, etc.))

What kind of support would be most helpful from the Pat Tillman Foundation right now?

Anything else you'd like us to know?

Contact Information