JAPANESE AMERICAN COMMUNITY GRADUATION PROGRAM COMMUNITY SERVICE SCHOLARSHIP APPLICATION FORM

JAPANESE AMERICAN COMMUNITY GRADUATION PROGRAM
COMMUNITY SERVICE SCHOLARSHIP APPLICATION FORM
2009

Return to Community Service Award Requirements
To apply for this award print and complete this form and send it to:

JACGP
P. O. Box 13665
Denver, CO. 80201-3665

Applicant's name:
Address:
City, State, Zip Code:
Telephone (Home):
Telephone (Work):
Parents’ names:
E-Mail Address:

Reason for eligibility:

_______1) American citizen of Japanese ancestry, Japanese surname: (first)______________________(last)_________________________________________(relationship) _____________________(i.e. Joe Tanaka-grandfather)

_______2) Permanent resident (INS Documentation) of Japanese ancestry**

_______3) Parent an active member of a participating organization

Name of Organization:

Graduating from:

List of non-school activities, hobbies, special skills or other pertinent information; church, community organizations, part-time or full-time work, experiences both during school and vacations, etc.

List of school activities, awards, honors, etc.; names of clubs or organizations, positions held, conferences, Odyssey of the Mind etc. Please do not use abbreviations. Use this format: Key Club 9,10,11,12.

List of activities involving the Japanese American community.

Use additional pages as necessary.

Agreement

The applicant, family members and any third party members agree, in participating in the Japanese American Community Graduation Program, that all decisions of the Committee and judges are final with regard to determinations of eligibility, qualifications, awarding of scholarships or any other matters, which affect the applicant. There is no right of appeal with respect to any decisions made by the Committee or judges. All applications and supporting documentation shall remain the sole property of the Japanese American Graduation Committee and shall not be subject to release to any persons.

_______________________________________________________________________Date_______________________________

Applicant's Signature

_______________________________________________________________________Date_______________________________

Parent or Guardian Signature (for minor under 18 years old)

** If eligibility is through an INS documentation, proof of permanent resident alien status is required with application. A photocopy is acceptable.

NOMINATION FORM JAPANESE AMERICAN COMMUNITY SERVICE AWARD

On occasions, these awards are given to recognize students who have performed OUTSTANDING community service or who have made personal sacrifices for others.

Academic achievement is NOT a consideration.

Nominee's name:
Address:
City, State, Zip Code:
Telephone (Home):
Telephone (Work):
Parents’ names:
E-Mail Address

Reason for eligibility:

_______2) Permanent resident (INS Documentation) of Japanese ancestry**

_______3) Parent an active member of a participating organization

Name of Organization:

Graduating from:

Give a brief description of community service/personal sacrifices:(use additional pages as necessary)

Two letters of recommendation must accompany nomination form.

Nominated by:
Address:
City, State, Zip Code:
Telephone (Home):
Telephone (Work):
E-Mail Address

Letter of Attestation of Volunteerism

This is a required form to receive an award.

Please respond where appropriate (type or print) One sheet per organization or event.

This letter of attestation is being provided on behalf of the following volunteer:

NAME:
ADDRESS:
CITY, STATE, ZIP

Japanese American Community Organization Name:

EVENT:
DATE OF EVENT:
DUTIES OR RESPONSIBILITIES:

I hereby certify that the information above is true, and an accurate representation of duties and responsibilities performed by the volunteer.

NAME:

Printed Name and Signature (may not be immediate family of volunteer)

TITLE: DATE:

PHONE # FOR VERIFICATION:

Attach other letters of attestation to this form for verification

Service Award 03/20/09

FORM B