Supervisor Elizabeth A. Pechous Town Clerk Thomas J. Pavlik Assessor David J. Avila Dear Berwyn Student: TOWNSHIP OF BERWYN "A Tradition of Service" Board of Trustees Amelia Sordelli Beverly Pastorek Donna Calvello Edward Espinoza Berwyn Township is pleased to announce that $3,000.00 of total funding for scholarships is being awarded to eligible 4 th through 8th grade students throughout the City of Berwyn. This money is to be utilized for education enrichment programs. Eligibility for the scholarship is as follows: 1. Must be a 4 th 8 th student currently enrolled in a City of Berwyn school; with a minimum average grade of B. 2. Must be a resident of Berwyn, Illinois. 3. Must have a history of extracurricular activities that demonstrate a willingness to accept leadership responsibilities and a willingness to serve the community (community service projects, volunteer activities with local service agencies or charitable institutions, etc.) 4. Must submit two letters of recommendation. The initial letter must be submitted by a teacher with the secondary letter coming from a counselor, local official, or business person. 5. Must submit a cover letter and a completed application form. 6. Scholarship funds must be applied toward an after school/summer academic program. 7. Monetary award will be paid directly to school/summer academic program. Please complete this application so we can determine your eligibility for receiving funds set aside to enrich your education. Complete your sections to this application no later than May 1, 2014 and forward the application to the Berwyn Township offices at 6600 W. 26th Street, Berwyn, IL 60402. If any questions are not applicable to your current situation, please attach an explanatory note referring to the questions by section. If more space is required for information on any items, you may attach additional information. Please indicate appropriate sections. You are responsible for seeing that all supporting documents are submitted. Berwyn Township reserves the right to process only applications found to be complete as of the application postmark deadline (May 1, 2014). Certification and Permission to use Recipient Information to Announce Scholarship Winners In submitting this application, I certify that the information provided is complete and accurate to the best of my knowledge. Falsification of information may result in termination of any scholarship granted. I agree that if I am offered an award from The Berwyn Township, The Berwyn Township may use my name, photograph or likeness, the name of my community, the name and address of my school, the amount of the award, and the name of the program I will be attending. I will attend (my Recipient Information ) in press releases, public announcements, and other fundraising or promotional materials in all media (including the Internet), to advance the non-profit objectives of The Berwyn Township Scholarship Program. Applicant s Signature Date Parent Signature (if student is less than 18 years old)
PERSONAL DATA (*must accompany application) List all school activities in which you have participated during the past 4 years (e.g., student government, music, sports, etc.). List all community activities in which you have participated without pay during the past 4 years (e.g. Red Cross, church work, volunteer work, Scouting). Indicate all special awards or honors. Activity No. of years participated Special Awards and Honors Make a statement of your plans as they relate to your educational objectives and future goals. *Please describe in 500 words or less what Berwyn means to you and how the program will enrich your education. Please attach a separate sheet.
PLEASE PRINT OR TYPE APPLICANT DATA Name (Last) (First) (Middle Initial) Permanent Address (Street) (City) (State) (Zip) Date of Birth (month/day/year) Telephone Number E-Mail Address Name of Parent/guardian: Permanent mailing address of parent/ Guardian if different from applicant: (Street) (City) (State) (Zip) Telephone Number:
SCHOOL DATA Grammar School/Middle School attending: Name of School Principal: School Address: School Phone Number: OTHER AWARDS Please list below the name and amount of any grants or scholarships that you have been awarded for the coming school year. Name of Award Amount Granted Pending
CHECKLIST 1. Cover Letter: Please submit a cover letter requesting consideration of your scholarship application. 2. Application: All sections of this application must be completed. The student must sign and date the application. 3. Essay: The student must write a 500-word essay on what Berwyn means to them and how the program will enrich their education. 4. Submit two letters of recommendation. All checklist items must be submitted together for a complete application. No exceptions will be made and all decisions are final. Faxes will not be accepted. All applicants should expect to receive written notification of a decision of their application after May 20, 2014. Notification of an award will not be given by telephone. One application will be sufficient for consideration for any scholarship offer by Berwyn Township during the year it is submitted. Any questions may be directed to Berwyn Township at 708-788-6600. Please mail your completed application, postmarked no later than May 1, 2014 to: Berwyn Township Attn: Education Enrichment Scholarship 6600 W. 26 th Street Berwyn, IL 60402