EmailMe Form - 2017 Drive for Excellence Entry Registration

Name *

First Last

Email *

Please provide a valid email address. If you do not provide a valid email address you will not receive important Drive for Excellence announcements and reminders.

Confirm Email

Primary Phone # *

### - ### - ####

Secondary Phone # *

### - ### - ####

Address: *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Date of Birth

You must be 16 years old at the time of the drawing on May 20, 2017 at 10am.

Month *

Day *

Year: *

Entry Information

High School *

If Not Listed, Name of HS

Year in School *

HS Senior (Class of 2017)

HS Junior (Class of 2018)

What marking periods are you registering for?

(You may register grades for any/all marking periods that end prior to the report card submission deadline of Wed., May 3, 2017, as long as those grades appear on your official report card and that report card has been submitted by the deadline.)

Please check all that apply *

1st Marking Period

2nd Marking Period

3rd Marking Period

If your high school uses a numeric grading system please note that entries will be awarded according to the following scale:
90% and higher = A = two entries
80% - 89.99% = B = one entry

1st Marking Period Grades

Any misrepresentation of grades will result in immediate disqualification of this year's Drive for Excellence.

1st Marking Period # of A's *

1st Marking Period # of B's *

2nd Marking Period Grades

Any misrepresentation of grades will result in immediate disqualification of this year's Drive for Excellence.

If you have NOT yet received 2nd marking period grades yet please enter '0'

2nd Marking Period # of A's *

2nd Marking Period # of B's *

3rd Marking Period Grades

Any misrepresentation of grades will result in immediate disqualification of this year's Drive for Excellence.

If you have NOT yet received 3rd marking period grades yet please enter '0'

3rd Marking Period # of A's *

3rd Marking Period # of B's *

Submitting Your Report Card (Progress Reports Will NOT Be Accepted)

There are 3 options for submitting your report cards. Once submitted the Drive for Excellence Program Director reserves the right to contact school officials to verify report card accuracy. Any misrepresentation of grades will result in immediate disqualification of this year's Drive for Excellence.

All report cards must be received by the close of business on Wednesday May 3, 2017. NO EXCEPTIONS

Options: *

I will be mailing my report card

I will drop off at Burlington Subaru

HS Guidance Counselor will email

HS Guidance Counselor will FAX

If mailing, please address to:
ATTN: Drive for Excellence
Burlington Subaru-Hyundai
333 Shelburne Road
Burlington, VT 05401

If emailing please send to:
d4e@burlingtoncars.com

If faxing please fax to:
ATTN: D4E
802-660-3400

If You're a Finalist!

For the lucky 75 who will have a chance to win a new car!

What Size T-Shirt? *

There will only be 75 t-shirts made (one for each finalist). You will not be able to change sizes, all sizes are unisex sizing.

Students must be present on May 20, 2016 at 10am in order to win. *

Yes, I understand that if selected as one of the 75 finalists I MUST be present on Saturday May 20, 2017 at 10am in the Burlington Subaru Showroom in order to win.

ABSOLUTELY NO EXCEPTIONS TO THIS RULE WILL BE ACCEPTED. Yes, we understand that this may result in conflicts with athletic contests, music festivals, proms etc., but if selected as a finalist you must be present to win. ABSOLUTELY NO EXCEPTIONS

A Few Last Questions

Just a few quick questions to help us continue to improve the Drive for Excellence program.

How Did You Hear About the Drive for Excellence? *

Any Suggestions or Comments?

I agree to the terms and conditions listed online at
http://www.burlingtoncars.com/drive-for-excellence-terms-and-conditions.htm *

Yes, I Agree