Scholarship
Smithtown High School East PTSA Community Service Scholarship February 2012 Dear Senior Class, It has been a tradition to honor students who have given outstanding service to our community by awarding them a Community Service Scholarship. This service can be through involvement in extra, co-curricular or community-involved activities done on a volunteer basis. Attached is a Smithtown High School East PTSA Community Service Scholarship application. Please complete and return your application in a sealed envelope to the PTSA mailbox in the Main Office. Applications are due by Friday, March 30th, 2012. You must be a current member of the Smithtown High School East PTSA. A selection committee will review all applications. The scholarship recipients will be presented with their awards at the Smithtown High School Senior Awards night. We encourage all eligible seniors to apply and wish all of you the best of luck in your future endeavors. This application is below and may be copied and pasted for printing. If you have any questions, please contact Ellen Ferrara, East PTSA President, at 979-1364 or by email at etony5@optonline.net Sincerely, Smithtown High School East PTSA
SMITHTOWN HIGH SCHOOL EAST PTSA COMMUNITY SERVICE SCHOLARSHIP Applicant Code: _____________ (assigned upon receipt) Name: ____________________________________________________________________ Address: __________________________________________________________________ Town: _____________________________________________ ZIP: ___________________ Telephone #: ______________________________________________________________ Email address: _____________________________________________________________ PTSA MEMBERSHIP # (located on your PTSA membership card): __________________ What are your plans after graduation from Smithtown High School East? __________________________________________________________________________ I certify that I am not failing any classes: ______________________ (please initial) I certify that all the information supplied on this application is true. __________________________________________________ ___________________ Signature of Applicant Date DEADLINE FOR APPLICATION SUBMISSION IS MARCH 30, 2012 SUBMIT APPLICATION TO THE PTSA MAILBOX IN THE MAIN OFFICE All information submitted in this application will be kept confidential. Please retain a copy of this application for your records.
Smithtown High School East PTSA Community Service Scholarship Applicant Code: _____________ (assigned upon receipt) SCHOOL AND COMMUNITY SERVICE For each organization, please provide a contact person, telephone number and/or email address to confirm participation. Please describe your involvement with each club/organization. Please add additional pages if necessary using the same format. School Year Name of in-school club/organization Office or Position Held 9, 10, 11, 12 ___________________________ ______________ Contact: __________________________________________________________________ Briefly describe this community service and the impact it has had on you: 9, 10, 11, 12 ___________________________ ______________ Contact: __________________________________________________________________ Briefly describe this community service and the impact it has had on you: 9, 10, 11, 12 ___________________________ ______________ Contact: __________________________________________________________________ Briefly describe this community service and the impact it has had on you: 9, 10, 11, 12 ___________________________ ______________ Contact: __________________________________________________________________ Briefly describe this community service and the impact it has had on you:
Smithtown High School East PTSA Community Service Scholarship Applicant Code: _____________ (assigned upon receipt) School Year Community club/organization (out of school) Office or Position Held 9, 10, 11, 12 ___________________________ ______________ Contact: __________________________________________________________________ Briefly describe this community service and the impact it has had on you: 9, 10, 11, 12 ___________________________ ______________ Contact: __________________________________________________________________ Briefly describe this community service and the impact it has had on you: 9, 10, 11, 12 ___________________________ ______________ Contact: __________________________________________________________________ Briefly describe this community service and the impact it has had on you: 9, 10, 11, 12 ___________________________ ______________ Contact: __________________________________________________________________ Briefly describe this community service and the impact it has had on you:
Smithtown High School East PTSA Community Service Scholarship Applicant Code: _____________ (Assigned upon receipt) PERSONAL STATEMENT Please respond to the following: What other information would you like to share with this committee about yourself that will help us evaluate your application?
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High School East PTSA
Smithtown
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