JAPANESE AMERICAN COMMUNITY GRADUATION PROGRAM
COMMUNITY COMMITTEE SCHOLARSHIP APPLICATION FORM
2009

Sponsored and funded by the Japanese American Community of the Denver Metropolitan area.

This form is used to apply to all Community Committee Awards.

Return to Community Committee Award Requirements
This form is used to apply for all Community Committee Awards.
To apply for these awards, 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(s) an active member of a participating organization

Name of Organization:

Graduating from:

Grade point average:

Class rank:

Number Graduating:

List of school activities, awards, honors, etc.; names of clubs or organizations, positions held, conferences, science fairs etc. Please do not use abbreviations. Use this format: National Honor Society 9,10,11,12, Vice-President 11.

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 activities involving the Japanese American community.

Use additional pages as necessary.

Please indicate whether you are willing to release the above information to other scholarship committees:

Yes___ No___

Agreement

The applicant, family members and any third party members agree, in participating in the Japanese American 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.

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

Community Award rev 03/20/09

FORM A