Please fill out all information below (Part I and Part II)
PART I
Personal Information
Name: (first, last)___________________________________________________
Preferred Name: ___________________________________________________
Address: _________________________________________________________
City, State, and Zip: ________________________________________________
Email: ___________________________________________________________
Home Phone: _____________________________________________________
Sex Male □ Female □
Country of Citizenship: ______________________________________________
PART II
Grant Recipient Explanation
In the space below please provide a detailed explanation of your intentions of use for a Humanitarian Fund grant award and how much you would like to receive for that purpose.
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Please note that the amount requested might not be the
actual amount given if the application is accepted. Our awards are given
based on the availability of funds.
This application can either be printed, filled out and mailed to:
Piedmont Silver Eagles Charitable Funds, Inc.
Capt. John Long
Humanitarian Fund
105 Hancock Crossing, Lake Wylie, SC 29710 (803) 746-5881
Or this application can be E-mailed to johnlong63@gmail.com
RECOMMENDATION
1
Part V.
Because we will have access to the academic letters of recommendations
in your Educational Scholarship Fund application,
we ask that someone who is familiar with your extracurricular or community
involvement complete this recommendation. We prefer that this be completed
by an advisor or mentor (not a family member) who has direct knowledge
of your leadership and/or your commitment to helping
Others.
To be completed by the candidate before giving to the recommender:
Student’s Name: __________________________________________________
E-Mail address: ___________________________________________________
Current School: ___________________________________________________
Under the Family Education and Privacy Act of 1974, which gives students
the right to inspect and review their education records, students may
waive their right to see specific confidential statements and letters
of recommendation. Please check one of the options below.
• Attach and mail this letter with the application and give a copy
of this letter to the recommender along with the Recommendation form
All applications, essays, & recommendation letters must be submitted
and postmarked by June 1st to Piedmont Silver Eagles Charitable Funds,
Inc., Educational Scholarship Fund, Capt. John Long, 105 Hancock Crossing, Lake Wylie, SC 29710 (803) 746-5881
Or this application can be E-mailed to johnlong63@gmail.com
Signature of Applicant______________________________________
RECOMMENDATION
2
Part VI.
To be completed by the recommender:
Name________________________________________________________
Organization__________________________________________________
Mailing Address_______________________________________________
City, State, Country, zip_________________________________________
E-Mail Address________________________________________________
The Piedmont Silver Eagles Charitable Funds Educational
Scholarship Fund is a scholarship based on merit. We seek students
who have demonstrated leadership potential, and a commitment to community
service, and whose behavior is grounded in strong ethical principal.
Please write a letter to help us better understand this student’s
inspiration and motivation for his/her accomplishments. You may want to
address this Candidates character, integrity, and life experiences.
How long have you known this student? __________________________________
In what capacity have you known this student? _____________________________
This form and the accompanying letter should be mailed and postmarked
no later than June 1st to: Capt. John Long, Piedmont Silver Eagles
Charitable Funds, Inc., Educational Scholarship Fund, 105 Hancock Crossing, Lake Wylie, SC 29710 (803) 746-5881
Or this application can be E-mailed to johnlong63@gmail.com
|