Foodland’s Shop for Higher Education
Nomination Instructions
This is a multi-part application which must be completed and received by Foodland Super Market, Ltd. by
Tuesday, March 31, 2015. Section I is completed by the school administration. Section II requires two letters
of recommendation be submitted. Section III is completed by the student nominee. All parts of the application
should be reassembled and submitted together. Page 2 must be signed by the high school principal, officially
nominating the student. A copy of the student’s most recent transcript must be submitted.
To be eligible, the nominee must:
 Be a high school student in his or her last semester and possess an outstanding
academic record.
 Be nominated for this scholarship through his or her high school principal.
 Have actively participated in a program or club that served the community.
 Have applied or plan to apply to an accredited four-year college for admission during
the next academic year (2015-2016). Recipients will be deemed ineligible for this
award if he/she attends a two-year or community college. Recipients must attend
college full-time.
In addition, the nominee should be individuals who exemplify the following character traits:
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are leaders and high achievers
are team players and excellent role models
have a sense of purpose and direction
are caring and compassionate
are respectful, humble, and honest
are dedicated to serving their community (serving others)
Maurice J. Sullivan, affectionately known as “Sully”, is the founder of Foodland Super Market, Ltd. The traits
listed above are inspired by the exemplary character Sully represented in both his professional and personal life.
The application questions are designed to identify a young person who has a mix of experiences and has
demonstrated qualities of personal character and behavior similar to Sully.
Please hand-deliver or mail all parts of this completed application (pages 2-6, letters of recommendation and
student transcript) to:
Juliet Garcia
Shop for Higher Education
Foodland Super Market, Ltd.
3536 Harding Avenue
Honolulu, HI 96816
Nomination forms are due by Tuesday, 3/31/15 and must be postmarked no later than 3/30/15.
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APPLICATION FORM – SECTION I
Academic Year 2014 – 2015
(To be completed by school officials.)
(Please print legibly.)
________________________________________
Student’s First Name
___________________
Middle Initial(s)
_________________________________________
Last Name
_________________________________________________________________________________________________________
Student’s Mailing Address
________________________________ _________
City
State
____________
Zip code
________________________________________________
Parent/Guardian’s Name
__________________________________________
Student’s Home Phone Number
________________________________________________
Parent/Guardian’s Phone Number
_________________________________________________________________________________________________________
High School
____________________________________________________ ___________________________ _________ ____________
School Mailing Address
City
State
Zip code
____________________________________________________________
Principal's Name (print)
________________________________________
School Phone Number
I have reviewed this completed application and I herewith submit my nomination for Foodland’s Shop for
Higher Education Scholarship. I have made my nomination without regard to gender.
____________________________________________________________
Principal’s Signature
______________________________
Date
2
SECTION I (CONTINUED)
Academic Year 2014 – 2015
(To be completed by school officials.)
1) Is this student currently in the last semester of his/her senior year in high school?
Yes_____ No_____
2) Has this student already been accepted to or is pending acceptance to an accredited four-year college or
university? For more information on a particular college or university, visit http://www.nces.ed.gov/ipeds/cool/
Yes_____ No_____
College or university student plans to attend: __________________________________________________
_______________________________________________________________________________________
3) Is this student in the top 20% of his/her class?
Yes _______ No _______
4) Please explain why this student has been selected for Foodland’s scholarship award.
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
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APPLICATION FORM - SECTION II
Academic Year 2014 – 2015
(To be completed by the student nominee.)
(Please print legibly.)
________________________________________
__________________
__________________________________________
Student’s First Name
Middle Initial(s)
Last Name
1) List two school service organizations for which you have been a member during high school and indicate the
amount of time you devote to each per week:
Organization: __________________________________________________________
#________ hours a week
Organization: __________________________________________________________
#________ hours a week
2) Select one of the above and describe your most significant contribution(s) as well as why your participation was most
meaningful to you:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
3) List two organizations or regular recurring activities that are non-school related that have been of great significance
to you, such as a specific volunteer activity, a particular job, church or club membership, and the amount of time you
devote to each:
Organization/Activity: ___________________________________________________________________________
_____ Volunteer
_____ Job
_____ Member
Other (describe) _______________________________________
#_____ hours
[ x ] per week or [ x ] per month (Place an ‘x’ in the appropriate box.)
Organization/Activity: ___________________________________________________________________________
_____ Volunteer
_____ Job
_____ Member
Other (describe) _______________________________________
#_____ hours
[ x ] per week or [ x ] per month (Place an ‘x’ in the appropriate box.)
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4) Name the four-year accredited college or university to which you have applied and plan to attend.
__________________________________________________________________________________
5) State what major subject area or course of study you plan to pursue.
__________________________________________________________________________________
6) List up to 4 school-related awards, honors or class offices you have achieved.
__________________________________________________________________________________
__________________________________________________________________________________
7) Describe your career goal when you have completed your post high school education and how you hope to contribute
to your community in the future.
__________________________________________________________________________________
__________________________________________________________________________________
(If additional space is needed, attach a separate sheet.)
I understand that as a nominee, my name may be released to the media and may appear in the newspaper, on the
radio, on television, and on Foodland’s website. I understand that, if selected, I must meet all eligibility criteria to
retain this award. If I do not attend a four-year accredited college/university on a full-time basis, I am not eligible
for this scholarship.
(Please print legibly.)
__________________________
First Name
______________________
Middle Name
_______________________________
Last Name
______________________________________________
____________________, 2015
Applicant’s Signature
Date
X X X – X X - _____ _____ _____ _____
Social Security Number (last four digits only)
_______/_______/_____________
Birth Date (MM/DD/YYYY)
____________________________________________________________________________________________________
Mailing Address
______________________________________
City
___________________
State
_____________________________________________
Home Phone Number
______________________
Zip code
_____________________________________________
Cellular Phone Number
_____________________________________________________________________________
E-mail Address
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FOODLAND’S SHOP FOR HIGHER EDUCATION SCHOLARSHIP
SECTION III - LETTERS OF RECOMMENDATION
Academic Year 2014 – 2015
The nominee should be individuals who exemplify the following character traits:
* are leaders and high achievers
* are team players and excellent role models
* have a sense of purpose and direction
* are caring and compassionate
* are respectful, humble, and honest
* are dedicated to serving their community (serving others)
Maurice J. Sullivan, affectionately known as “Sully,” is the founder of Foodland Super Market, Ltd. The traits
listed above are inspired by the exemplary character Sully represented in both his professional and personal life.
The letters of recommendation should identify a young person who has a mix of experiences and has
demonstrated qualities of personal character and behavior similar to Sully.
Two Letters of Recommendation
 Scholarship nominees must submit 2 letters of recommendation.
 They must be submitted only by adults.
 They should not be submitted by a relative.
 At least one letter must be from a school faculty member (teacher, counselor or administrator) who has
known the student for at least 2 years.
 One letter may come from an employer, community-service leader or member of the community who
has known the student for at least 1 year.
The letter of recommendation must answer these questions:
 How long have you known the scholarship nominee?
 In what capacity have you known the scholarship nominee?
 Why should this student be considered for Foodland’s scholarship award?
The school faculty member’s letter of recommendation should address these topics:
 A course or area of study in which this student has excelled.
 School-related activities and how this student has demonstrated leadership skills, the ability to be a team
player and individual achievement.
 The student's character or behavior in relation to demonstrating caring, compassion and service to others.
The employer, community-service leader or community member’s letter of recommendation should:
 Describe the general character of the student.
 Describe student's character or behavior in relation to demonstrating caring, compassion and service to
others.
 Name non-school related honors, awards, contests or leadership positions this student has achieved.
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NOMINATION APPLICATION FORMS CHECKLIST
Please submit the following for each student nominee:
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[
Application Form - Section I (pages 2-3)
To be completed by school officials.
All sections must be completed.
Page 2 requires the signature of the principal nominating student.
] Application Form - Section II (pages 4-5)
To be completed by the student nominee.
All sections must be completed.
Page 5 requires the student’s signature.
Page 5 requires the (last four digits) of the student’s Social Security number.
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[
] Two Letters of Recommendation- Section III (page 6)
[
] Student’s Most Recent Official Transcript
Please DO NOT include a personal resume or any other items not requested.
Any unrequested items that are submitted will be discarded.
Please hand-deliver or mail all parts of this completed application (pages 2-6) and the student’s transcript to:
Juliet Garcia, Community Relations
Shop for Higher Education
Foodland Super Market, Ltd.
3536 Harding Avenue
Honolulu, HI 96816
Nomination forms are due by Tuesday, March 31, 2015.
Must be postmarked no later than Monday, March 30, 2015.
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