The Hodgin Character Achievement AwardApplication Form Recognizing Students of Exemplary Character
Application Deadline: March 27, 2008 Please return application to Lawrence Township School Foundation
I. Student Information Student Name______________________________________ Social Security Number _____________________________ Home Address________________________________________________________zip______________ Home Phone_____________ E-mail Address__________________________________________ Date of Birth____________Expected Graduation Date______ Name and Address of College, Community College or other institution you plan to attend: _______________________________________________ __________________________________________________________________ Intended Postsecondary Field of Study or Educational Plans:_________ __________________________________________________________________
II. Parent Information Parent or Guardian Name__________________________________________ Address__________________________________________________________ Home Phone____________________Work Phone_______________________ Student Residing With___Father___Mother___Both___Other(_________) Father’s Occupation___________________________________ Mother’s Occupation__________________________________ Number of Siblings__________Others in College?___________ E-mail Address_______________________________________
III. High School Data All relevant information must be included, with appropriate signature, High School _______________________________________G.P.A.________________ Seventh Semester Rank _____ out of _____ Students Signature of Principal or Counselor________________________________________ Date_________________________ **Character Verification** Please attach a written character reference from at least two classroom teachers or administrators. (Length is not important.) No application will be considered without this portion completed.
IV. Extra-Curricular Activities and Community Involvement (Attach additional sheets, if desired)
A. High School (Scholastic Awards, Honors or Recognition) __________________________________________ __________________________________________ __________________________________________ B. Extra-Curricular Activities Name No. of Years Special Achievement ______________ _____ ________________ ______________ _____ ________________ ______________ _____ ________________ ______________ _____ ________________ ______________ _____ ________________ ______________ _____ ________________ C. Community Service Name No. of Years Special Achievement ______________ _____ ________________ ______________ _____ ________________ ______________ _____ _________________ D. Church/Synagogue Involvement Name No. of Years Special Achievement ______________ _____ ________________ ______________ _____ ________________ ______________ _____ ________________ V. Of your community or church related activities, select one and explain why this experience was most meaningful to you. (Use space below.) __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ VI. Essay Statement: Explain in your own words the meaning of the following…….”Our Character Determines our Destiny” Heraclitus (100 words or less) __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ Attach a typed statement of 200 words or less about your future goals and how you plan to achieve these goals. The application plus nine copies must be submitted to the Lawrence Township School Foundation on or before Thursday, March 27, 2008. 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. Applicant's signature _________________________________________ Date__________________ Lawrence Township School Foundation
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