Glen Rock Women in Community Service 2015 Scholarship Application Glen Rock Women in Community Service will be granting a $1,500 scholarship to a female high school senior who is a resident of Glen Rock, NJ. The scholarship will be awarded to the applicant who best exemplifies a commitment to both our town and to community service in general as evidenced by her impact on the community around her. We envision this senior as having taken a leadership role in at least one community service project. Her application should reflect a pattern of participation that shows a commitment to helping others, especially right here in Bergen County. Some applicants may have participated in multiple, smaller projects; others may have focused on one major project over a long period of time. We want to know what role the applicant herself had in changing the lives of those around her, as evidenced by the total number of hours volunteered and the quality of those hours. It is important to note that we will not count as "community service," hours for which the applicant was paid (even if the work performed was in a service industry), or hours "volunteered" in babysitting a sibling or assisting a grandparent. Please note: we cannot accept applications from high school seniors whose mothers are or have been members of WICS within the previous two years. Name:_________________________________________________________________ Parent(s) Names: _______________________________________________________ Address:_______________________________________________________________ Home Phone #: _________________________________ High School Attending ______________________________________________ High School Address: ___________________________________________________ Guidance Counselor:_____________________________________________________ 1 1. List, in order of importance up to (six) community service projects in which you have participated. Service Project Date from/to Total Hours 2 Description 2. In 500-750 words, please describe the community service project listed above that best exemplifies a commitment to both our town and to community service in general. In detail, explain the project, your involvement in it and how your contribution made a positive impact on the lives of those in your community. How did this project change you? Your essay should be attached to this form. We will not consider applicants who attach anything other than the essay to this application (do NOT include photos, lists of extra-curricular activities, transcript, awards or news articles). 3. Reference: Please provide a reference for the service project described in your essay. Name: __________________________________________________________ Phone Number: _____________________________________________________ 4. Please send completed applications via email (inPDF form) to [email protected] or by mail to Glen Rock WICS, P.O. Box 921, Glen Rock, NJ 07452. All applications must be received by April 27, 2015 at 3pm in order to be considered. I affirm that I have read and followed the instructions to the best of my ability, and that all information submitted on this application is true to the best of my knowledge. Applicant’s Signature: Parent’s Signature: 3