Silent Servant Scholarship Award - Nomination Form

Nomination Submission Period:
Anytime between August 15th and 30 days prior to the end of your school year.

To nominate a student for the Silent Servant Scholarship Award:

Review all eligibility guidelines and service work criteria to verify that the student-nominee qualifies for the Award.
Complete and submit this form electronically.

Once a nomination has been received by the Foundation, you may be contacted to provide additional information.

ONLINE NOMINATION FORM

All fields required unless noted.

"*" indicates required fields

Student Nominee Information

Name of Nominee*

Year in School*

What service(s) has this student provided in their community? Please be specific rather than generalized.*

Nominator Information

Your Name*

Title / Position at your school*

Phone (include ext.)*

Cell Phone (optional)

Email*

School Information

School Name*

Estimated number of students that attend your school:*

Principal's Name*

Principal's Email*

U.S. Mail Address*

FedEx/UPS Address*

School Social Media Addresses/Tags*

Dates of your school year:

Start Date*

End Date*

Is peaceful student behavior a priority at your school?*

Yes

Is empathy purposely taught to the students in your school?*

Yes

If “Yes”, how is this accomplished?

What is the estimated number of students that would be gathered for the Award presentation’s “teachable moment” of empathy?*

What forum will be used for the Award presentation gathering?*

Publicity of Award Recipient and School

You may choose to distribute any Student Award media coverage yourself (press release and/or social media postings), or you can choose the Foundation to do so. If you choose the Foundation to provide this service, complete and submit the Media Release Template.

What is the name and email of the Media/Communications Director for your High School?*

Projected date of the presentation (if known)?*

Please confirm that all sections of this form have been completed before submission.

Public service builds academic success, creates a better mindset for student learning, develops social/emotional intelligence and cultivates empathy. The students, your school and the community are beneficiaries of participation in the Student Silent Servant Award program. Thank you for this student nomination and your desire to enhance a more peaceful, productive society.

Peter R. Marsh Foundation