President's Message

OHIO ELKS ASSOCIATION

TEENAGER / STUDENT OF THE YEAR
APPLICATION

INDIVIDUALS NOMINATED FOR THIS AWARD MUST BE A SENIOR IN HIGH SCHOOL. THE AWARD IS JUDGED ON THE BASIS OF SCHOLASTICS, LEADERSHIP, ACTIVITIES, AND COMMUNITY INVOLVEMENT. PLEASE INCLUDE A CURRENT PICTURE, IF AVAILABLE

STUDENT FULL NAME:____________________________________________________

first

middle int.

last

ss#

HOME ADDRESS:_________________________________________________________

street

city

state & zip code

E-mail address:______________________________

PHONE #_______________	BIRTH DATE:___/___/___	PARENTS NAME:_________________
	month/day/year

SCHOOL:_________________________

GPA: _____

CLASS STANDING________

FUTURE GOALS:__________________________________________________________

_________________________________________________________________________

PLEASE ATTACH ON A SEPARATE SHEET DETAILED INFORMATION WITH EACH TOPIC. INCLUDE YEARS OR NUMBER OF TIMES YOU PARTICIPATED WITH EACH PROGRAM

TOPICS:

ACTIVITIES /PERSONAL ACHEIVEMENTS
VOLUNTEER ACTIVITIES / SCHOOL AND
CIVIC PROGRAMS

ALSO, INCLUDE THE FOLLOWING INFORMATION WITH EACH APPLICATION:

1) LIST ANY HOBBIES AND EMPLOYMENT HISTORY

2) LETTER OF RECOMMENDATION – EITHER BY PRINCIPAL – TEACHER – COACH OR CIVIC LEADER (MAX. 2 PERMITTED)

3) ESSAY, NOT EXCEEDING 400 WORDS, DESCRIBING ONE PARTICULAR EXPERIENCE FROM ANY ACTIVITY

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

SUBORDINATE LODGE ONLY:

LODGE NAME: _____________________________________________ NUMBER_____

LODGE OFFICER /
COMMITTEE CHAIRPERSON NAME: _________________ TITLE _________________

LODGE OFFICER / DATE:
COMMITTEE CHAIRPERSON
SIGNATURE _______________________________________ ____/____/____

E-mail address: _________________________________

Home phone number

Jean A. Zink, State Chairman Youth Activities Committee Ohio ELKS Association

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