Memorial Service Awards to be presented on June 14th PFC Ross McGinnis Memorial Service Award Application Applications must be post marked by May 31st Send Completed Applications to: Ross McGinnis Memorial Service Award Keystone SMILES P O Box 352 Knox, PA 16232 Eligible to apply for one award per year Initial the appropriate award for competition. _____$1,500 Honor Service Award Available to a Student or Alumni of a County within the Keystone SMILES network – see regional map below. _____$1,250 Silver Service Award Available to a Student or Alumni of a Clarion County Public or Private School Name of Clarion County School: ____________________________________ _____ $750 Bronze Service Award Available only to Student or Alum of: _____Clarion Career Center These Memorial Awards recognize young leaders who have demonstrated outstanding humanitarian efforts and citizenry activities while serving their community, school, church, and country. ______Keystone High School _____Keystone SMILES Alternative Education Program Keystone SMILES Inc. www.smilesamericorps.org Ross McGinnis Memorial Service Awards Application Eligibility: High School Seniors and Post Secondary Students ELIGIBILITY/ APPLICANT REQUIREMENTS • • • • • • • • Must demonstrate participation in an outstanding service project or activity addressing human needs, environment, public safety or education which benefited an individual or group. The Honor “Service” Award - must have attended or currently attends a high school or post secondary school located in a county identified on the regional map. (Refer to map illustration.) The Silver “Service” Award - must have attended or currently attend a Clarion County Public or Private School and be enrolled in a post-secondary technical / career / educational institution to access the award. The Bronze “Service” Award – must have attended or currently attends Keystone High School, Clarion Career Center or Keystone SMILES Alternative Education Program and be enrolled in a post-secondary technical / career / educational institution to access the award. Has not been a recipient of this Award previously. This is a one-time award. Must have a minimum of 2.75 GPA at time of application and Award disbursement. Must be a U.S. citizen or permanent resident. Applicant agrees to be present at the annual Award Ceremony to be held at the Keystone SMILES Community Learning Center in Knox, PA. AWARD INFORMATION The Honor “Service” Award will be in the amount of $1,500. Eligible applicants must be a current student or alumnus of a school within a county identified on the regional eligibility map. • Award will be released only to the post-secondary school the recipient is attending. Funds will be released after recipient completes one school year of post secondary education with a GPA of 2.75 or higher. The Silver “Service” Award will be in the amount of $1,250. Eligible applicants must be a current student or alumnus of a Clarion County school. • Award will be released only to the post-secondary school the recipient is attending. Funds will be released after recipient completes one school year of post secondary education with a GPA of 2.75 or higher. The Bronze “Service” Award will be in the amount of $750. Eligible applicants must be enrolled or be an alumnus of Keystone High School, Clarion County Career Center, or Keystone SMILES Alternative Education Program. • Award will be released only to the post-secondary school the recipient is attending. Funds will be released after recipient completes one school year of post secondary education with a GPA of 2.75 or higher. ATTACHMENTS In addition to this completed application, the student must submit; • ___High school transcript, copy of high school diploma or letter from high school administrator verifying attendance. • ___Letter describing participation in an outstanding service project written by supervisor, sponsor or recipient of the service. (Please be sure author includes contact information) • ___1 character Reference Letter • ___Picture for press purposes and signature on photography release. • ___ 500-1000 word typed essay documenting service project or activity • ___Resume’ of education, work experience and other community service contributions. Use resume sample format enclosed in application. Service Making an Impact through Learning Experiences with Students Copyright 2006 Keystone SMILES, Inc., 10/4/2011 www.smilesamericorps.org Ross McGinnis Memorial Service Awards Application Eligibility: High School Seniors and Post Secondary Students Application Form Applicant Information Full Name: Date: Last First M.I. Address: Street Address Apartment/Unit # City State Phone: ( ) Alternate Phone: Birth Date ( Social Security No.: ZIP Code ) Email Address: Indicate if applicant attended: Keystone High School. Year(s) attended: ________________ Clarion County Career Center. Year(s) attended: ________________ Keystone SMILES Alternative Education Program. Year(s) attended: ________________ Other Clarion County School District: Name ____________________________ Year(s) attended:________________ Other School located in Region: Name: ___________________________ Year(s) attended:_______________ YES NO Male Female Are you a citizen of the United States? College Information/ Technical School/ Etc Post Secondary School Student plans to attend or is currently enrolled. State: City: Zip: Enrollment Date: High School Information Full Name of High School: School Address: ____________________________________________________________________ __________________________________________________________________________ City: State: Zip: ____________________ Contact Name: School Phone: Contact Email: Summer Phone: __________________________ Publicity Release If selected to receive a Memorial Service Award, Keystone SMILES may use my name and/or picture for the purpose of the Award announcements. I agree to the above statement and will enclose a picture for the purpose of this Award Student Name: Signature Date: Signature Date: Print Name Parents Name: Print Name ( if applicant is 17 or younger) Service Making an Impact through Learning Experiences with Students Copyright 2006 Keystone SMILES, Inc., 10/4/2011 www.smilesamericorps.org Ross McGinnis Memorial Service Awards Application Eligibility: High School Seniors and Post Secondary Students Applicant Service Information Approximate number of hours served /serving community # of years applicant has been volunteering for community service: (ex:1999-2006): The applicant’s outstanding service was with: ______________________________________________________________________________ ( list organization(s) or volunteer program( s) Please classify the types of service experiences by checking all boxes that apply: Health Drug/Alcohol Prevention Teen Pregnancy Prevention Smoking Prevention Hospital/Clinic Support Public Health Activities Other Health Education List _________________ Environment Community Improvement Community Gardens Parks and Trails Water Testing/Clean up Endangered Species Lead Avoidance Reflection Questions Please select the setting in which the majority of the your service was completed: Class/course Self initiated/outside of organized setting Club/other organized activity outside of school Education Public Safety Literacy Tutoring / Mentoring Coaching /Homework Help Supporting Out of School Activities Big Brothers/Big Sisters ESL Tutoring Promoting Tolerance/ Diversity Youth Serving Youth Homeland Security Disaster Relief Disaster Preparedness Violence Prevention Conflict Resolution / Mediation Community Policing Bike Safety Auto Safety Other Human Needs Elderly Assistance Hunger/Homelessness Other______________ List_____________ Service Making an Impact through Learning Experiences with Students Copyright 2006 Keystone SMILES, Inc., 10/4/2011 www.smilesamericorps.org Please indicate the ways in which you have documented your service: Kept a journal Discussed service in class related to course content Wrote a research paper/ Wrote a factual piece Through Media or Event Wrote or preformed a play Wrote or performed music Painted, drew or sculpted Wrote a fictional piece Discussed with family and/or friends Other________________________________ ________________________________ Ross McGinnis Memorial Service Awards Application Eligibility: High School Seniors and Post Secondary Students CERTIFICATION I (applicant name) application is true and is accurately documented. verify the enclosed information submitted with this Applicant Signature ____________________________________________________ Date: _____ /_____ /______ If 17 years of age or younger, parent signature is required: Parent or Guardian Signature_____________________________________ Date:_____/____/_____ Parent Information Contact Phone Number: ______________________ email address: ____________________________________ Before sending in application, please complete the following checklist to ensure you have enclosed all required paperwork. Please √ Required Paperwork Completed Application Completed Resume 500-1000 word Essay of Outstanding Service Service Reference Letter Character Reference Letter Documentation of High School Attendance and GPA (High School Diploma and either High school / College Transcripts) Picture for Media Release Service Making an Impact through Learning Experiences with Students Copyright 2006 Keystone SMILES, Inc., 10/4/2011 www.smilesamericorps.org Ross McGinnis Memorial Service Awards Application Eligibility: High School Seniors and Post Secondary Students John Doe Use this resume format when creating your resume as part of your application. 1234 Roman Drive, Knox PA 16232 814-797-1111 - jdoe@youremail.com Education Year(S) Gannon University , Erie PA Business Administration Minor - Marketing Clear Creek High School, Clarion County General Studies - QPA 2.90 Immaculate Conception Elementary School Kindergarten-eight grade Memberships in clubs, organizations and sports President Student Council 4-H Club member th Rising Stars AAU Coach - 7 grade Awards/recognition Keystone SMILES Charity Challenge President Youth Scholarship Award Volunteered 300 hours of community Service 2004 4 -H Outstanding Youth Volunteer Award Service EXPERIENCE – Includes Volunteer, National, or Military Youth Field Day Volunteer Sunday School Bible School Aide Service Volunteer Serve in a summer youth corps program mentoring youth ages 10-14 Work Experience Wal-Mart Cashier Customer service, cashier-summer Clarion PA Katie’s Ice Cream Shop Strattanville, PA Service Making an Impact through Learning Experiences with Students www.smilesamericorps.org 1999-2004 1991-1999 Year (s) 2001-2002 1995 – 2004 Clear Creek High School – Basketball Team Copyright 2006 Keystone SMILES, Inc., 10/4/2011 2004-present 1999-2003 1997-1998 Year (s) 2004 2003 Year (s) 2005-Present 2001-2004 1995 - 1999 Year (s) 2003-present 1999-2000