2016 SCHOLARSHIP APPLICATION

Transcription

1 2016 SCHOLARSHIP APPLICATION EASTON CHAMBER OF COMMERCE COMMUNITY SERVICE AWARD $ Contact: Kerri Nichols, Program Director Easton Chamber of Commerce, P.O. Box 69, Easton, MA Ph ,

2 2016 Community Service Scholarship Application Complete all four pages INSTRUCTIONS Application must be filled out by applicant. Please read all instructions before completing this form. 1. Make sure you are eligible. Applicants must be individuals enrolled in grade 12 and must reside in Easton. 2. Make sure your activity is eligible. Must be a service activity that supported the local community and its citizens. *Activity should have been performed at least in part in the current year* 3. Applicants for this award must be pursuing an education at an accredited institute of higher learning. 4. Proof of acceptance to an institute of higher learning will be required prior to disbursing the scholarship money. 5. Fill out the four-page application form completely and accurately in your own words in the space provided. Use a computer, typewriter or black ball-point pen (if using a computer, tape or paste each answer in at least 10-point type beneath each question.) Do not attach additional sheets. Applications must be written in English or translated into English prior to submission. Applications filled out by a parent or other adult will be disqualified. All information provided is subject to verification: False, inaccurate, illegible, or reformatted applications will be disqualified. Application must be submitted to the Guidance Office by December 6, APPLICANT INFORMATION please print clearly. Applicant s name Last Name First Name Middle Initial Home Address Street (no P.O. Boxes) City/Town State Zip Male Female Date of birth (month/day/year) / / Applicant s Phone Applicant s address School currently attending Name City/Town State Names of parents/guardians Parent/guardian work phone PROJECT SUMMARY Briefly answer the following questions within the space provided (no additional sheets), then provide more detail in the following sections. What was your volunteer community service project? How did you become involved in this project? What role did you play in the project? Approximately how many hours did you spend on this project? When did you start working on the project? How long did it last? 1

3 PROJECT SUMMARY (cont d) How did your project impact others? Which of these categories best describes your project? healthy community youth achievement public safety environment/parks/open spaces Please provide a reference that we may consult with regarding your volunteer time or project: Contact Name Phone Number INSPIRATION Briefly explain what motivated you to do your project. How did you come up with the idea for your project? Who or what inspired you to begin your project and how did it begin? Why did you feel it was important? EFFORT Briefly explain the effort required to do your project. What exactly did you do, and how did you do it? What steps did you have to take to accomplish your goal? Did you recruit others to help, or did you work with an local or national organizations? If yes, explain. What was the most difficult part of your project? 2

4 IMPACT Briefly describe what your project accomplished. Who benefited from your activity, and how? How many people were involved or directly affected? If your activity involved fundraising, how much did you raise? Will your project continue in the future? PERSONAL GROWTH Briefly describe what you, yourself, got out of the project. What did you learn from your experience? Did you acquire any new skills? What was the most memorable part of this activity? Can you recall a specific incident that made you feel particularly good about your project? What would you tell other young people about your experience? 3

5 APPLICANT AGREEMENT Must be completed by applicant and parent/guardian. Signature of Applicant Date Signature of Parent/Guardian Date REQUIRED CERTIFICATION ALL APPLICANTS MUST BE CERTIFIED BY THE HIGH SCHOOL GUIDANCE, HIGH SCHOOL PRINCIPAL, OR HEAD OF THE ORGANIZATION REPRESENTED Please print clearly. Certifiers Name Mr. Ms. Dr. Last Name First Name Name of School or Organization Address Street City/Town State Zip Telephone Number Fax Number address I certify that the individual named in this application represents this school or organization. Signature Date The applicant selected for this award will be honored at the annual Easton Chamber of Commerce Business Appreciation Night scheduled for Thursday, January 26, This event will be held at the Easton Country Club and is complimentary attendance for the recipient and their family. Contact: Kerri Nichols, Program Director Easton Chamber of Commerce, P.O. Box 69, Easton, MA Ph , kerri@easton-chamber.com, 4