Applicant’s Name:    	

PART 2: SCHOLARSHIP QUESTIONNAIRE

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Code:

Please list your top four college choices. Place an asterisk (*) next to any schools where you have been accepted.

1st		2nd	
3rd	
 		4th	

Significant Voluntarism
Organization	Supervisor	Responsibility	Dates of Service	Weeks Per
Year	Hours Per
Week	

						

Major Extracurricular Activities
Activity	Position Held	Weeks
Per Year	Hours Per
Week	Honors Received	

					

Work Experience
Employer	Nature of Work	Employment
Dates	Weeks Per
Year	Hours Per Week	

					

Awards and Honors

Applicant’s Name:    	

League Use Only

Code:

PART 3: ESSAY QUESTIONS 
1.	Please describe and discuss your volunteer experience. How has your experience benefited you and your community? If applicable, explain how your volunteer experience has contributed to the formation of your career plans. Please attach your 1 page essay.

2.	Imagine you’re given $100,000 to start your own non-profit organization. What would you do? Please limit your response to 500 words.

League Use Only

Code:

Applicant’s Name:    	

PART 4A: GUIDANCE COUNSELOR RECOMMENDATION FORM – Page 1

EVALUATION:
In the space below, please describe the applicant’s service contribution to her school and community. Although this scholarship rewards excellence in voluntarism, we welcome your comments and observations on her academic achievement and overall extracurricular participation.

Applicant’s Name:    	

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Code:

PART 4A: GUIDANCE COUNSELOR RECOMMENDATION FORM – Page 2

School:

Counselor’s Name:

Phone Number: E-mail:
Counselor’s Signature:

Date:

Please affix a school stamp, seal, or letterhead to this document to verify its contents and mail to:

Junior League of Greater Springfield C/O Alison Bartlett-O’Donald
PO Box 2634
Springfield, MA 01101

Please send all material paper-clipped, not stapled.

Application and all supporting materials must be postmarked by Saturday, April 27, 2019.

Applicant’s Name:    	

League Use Only

Code:

PART 4B: VOLUNTEER SUPERVISOR’S RECOMMENDATION FORM – Page 1

EVALUATION:

In the space below, please describe the applicant’s service contribution to your organization. Although this scholarship rewards excellence in voluntarism, we welcome your comments and observations on her personal qualities as well as the quantity and quality of her work.

Applicant’s Name:    	

PART 4B: VOLUNTEER SUPERVISOR’S RECOMMENDATION FORM – Page 2

RATINGS:
In comparison to other school-age volunteers at your organization, please describe this student in terms of:

No basis		Below
Average	Average	Good	Very Good	Excellent	
	Quality of service
contribution to this organization						
	Quantity of service
contribution to this organization						
	Personal qualities and
characteristics						

Organization: Supervisor’s Name: Phone Number:
E-mail:

Supervisor’s Signature:

Date:

Please affix your organization’s stamp, seal, or letterhead to this document to verify its contents and mail to:

Junior League of Greater Springfield C/O Alison Bartlett-O’Donald
PO Box 2634
Springfield, MA 01101

Please send all material paper-clipped, not stapled.

Application and all supporting materials must be postmarked by Saturday, April 27, 2019.