Silent Servant Scholarship Award - Nomination Form

Nomination Submission Period:
Anytime between September 1st 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

Nominator Information

How do you propose a "teachable moment" will be accomplished?*

PLEASE READ: Student participation in community service fosters self-worth and personal pride. Students who acquire these qualities attain higher grades and conduct themselves peacefully. The primary purpose of this Scholarship Award is to provide your school with a compelling peer-to-peer learning experience which supports your administration’s goals of productive classrooms and a safe campus. This ”teachable moment” is effectively accomplished during a gathering of numerous freshman, sophomore and junior-year students and incorporates the personal testimony of the Scholarship Award recipient. How do you propose this will be accomplished?

What is the estimated number of students that will be in attendance when the Scholarship Award is presented?*

Can you arrange for your Scholarship Award Recipient to provide their personal testimony during the Award presentation?*

Your Name*

Title / Position at your school*

Phone (include ext.)*

Cell Phone (optional)

Email*

Student Nominee Information

Name of Nominee*

Year in School*

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

School Information

School Name*

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*

Estimated number of students that attend your school:*

What is the estimated number of freshman/sophomore/junior students that will be present when the Scholarship Award is presented?*

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 are encouraged to post the award event on social media and distribute a press release to your local media. Permission is granted to use the Foundation’s name for this purpose.

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, and cultivates empathy. The students, your school and the community are beneficiaries of participation in the Silent Servant Scholarship Award program. Thank you for this student nomination and your desire to enhance a more peaceful, productive society.

Peter R. Marsh Foundation