Future Leaders Scholarship Program Recommendation Form SCHOOL INFORMATION EDUCATOR INFORMATION

Transcription

1 Recommendation Form APPLICANT NAME: DIRECTIONS: Please complete this form and attach it to your letter of recommendation. Your letter should be printed on official school letterhead and address your involvement or supervision of the student s activity. SCHOOL INFORMATION SCHOOL NAME: SCHOOL PHONE: SCHOOL ADDRESS: EDUCATOR INFORMATION EDUCATOR NAME: EDUCATOR JOB TITLE: BRIEFLY DESCRIBE INVOLVEMENT WITH STUDENT PROJECT:

2 Recommendation Form APPLICANT NAME: DIRECTIONS: Please complete this form and attach it to your letter of recommendation. Your letter should be printed on official organization letterhead and address your involvement or supervision of the student s activity. COMMUNITY ORGANIZATION INFORMATION ORGANIZATION NAME: ORGANIZATION PHONE: ORGANIZATION ADDRESS: ORGANIZATION REPRESENTATIVE INFORMATION REPRESENTATIVE NAME: REPRESENTATIVE JOB TITLE: BRIEFLY DESCRIBE INVOLVEMENT WITH STUDENT PROJECT:

3 DIRECTIONS: Please complete this form in its entirety. This form should be attached as the first page of your application. Applications must be post-marked no later than March 31, 2016 and received by April 8, employees and their families are not eligible. On a separate sheet of paper, describe your community volunteer activity in no less than 500 words and no more than Your essay must address what volunteering means to you and how your efforts have helped to make our community a better place. All essays must be typed. You may attach newspaper clippings or any other printed materials that support your application. A copy of your school progress report or transcript indicating GPA average must be supplied. Only applications that include this form, an official copy of your transcripts, the student essay, teacher/school recommendation letters and recommendation forms, and verification/support of applicant letter from the organization will be reviewed. School and organization letters should be printed on official letterhead. Please note that all applicants must reside within a Bright House Networks service area in Alabama, California, Florida, Indiana and Michigan as defined in the full rules. APPLICANT INFORMATION STUDENT NAME: ADDRESS: HOME/CELL PHONE: ADDRESS: GENDER: Female Male AGE: SCHOOL INFORMATION HIGH SCHOOL: GRADE: GPA: SCHOOL ADDRESS: PHONE: PRINCIPAL NAME: SIGNATURE OF PRINCIPAL: 1

4 Applicants must be seniors in good standing (minimum 2,5 GPA) currently enrolled in a public or private high school at the time of submitting the application and at least 16 years of age. Applicants must reside in and attend high school within their service area. Bright House Networks employees and their immediate family are ineligible. * Please note materials submitted with application will not be returned. Completed application may be mailed or hand-delivered during regular business hours to any one of the following addresses. Hand delivered applications must be received by March 31, Mailed applications must be postmarked by March 31, 2016 and received no later than April 8, Alabama California Florida 151 London Parkway Birmingham, AL California Avenue, Suite A Bakersfield, CA Orange, Osceola, and Seminole Counties: 485 N. Keller Rd. Maitland Flagler and Volusia Counties: 1475 S. Nova Road Daytona Beach, FL Brevard County: 720 Magnolia Avenue Melbourne, Pinellas County: 700 Carillon Pkwy St. Petersburg, FL Hillsborough and Polk County: 4145 S. Falkenburg Road Riverview, Florida

5 Manatee County: 5413 SR 64 East Bradenton, Florida Citrus, Hernando, Lake, Marion, Pasco, and Sumter Counties: Moon Lake Road New Port Richey, FL Indiana Michigan 3030 Roosevelt Avenue Indianapolis, IN Farmington Road Livonia, MI