student information - dearborn high school · [email protected] or mail: aaa michigan ....

AAA Michigan Public Affairs Department

1 Auto Club DriveDearborn, MI 48126

[email protected]

Student CertificationI certify that the application submitted meets with the rules and conditions of the AAA School Safety Patrol Scholarship in Michigan. I agree by signing below that I have abided by the rules and give consent for my name, likeness, and/or photograph to be used without compensation in all promotional materials concerning this scholarship. I understand that the decision of the scholarship committee is final in all respects. I hereby acknowledge that all materials submitted will become the property of AAA Michigan.

Student Information

Date: _________________________________________

All applications must be received by May 12, 2017.

This form may be photocopied.

AAA School Safety Patrol Scholarship Application

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Name: ________________________________________

School: ________________________________________

Birth Date: _____________________________________

Phone: ________________________________________

Home Address: __________________________________

City: __________________________________________

State: _____________________ Zip: _______________

Email: _________________________________________

Signatures

Student: _______________________________________

Parent/Legal Guardian: ____________________________

AAA Michigan


2016-2017

• By submitting the scholarship application,participants expressly agree to the rules andthe decisions of the Committee.

• The scholarship recipients are the only studentswho will receive a notification letter. The letterwill be sent no later than June 17, 2017.

• Scholarships will be awarded in the name of thestudent and the institution of higher learning.

• Scholarship recipients must provide proof ofacceptance to an accredited institution of higherlearning.

• Scholarships are not transferable or redeem- able for cash at any time.

• Scholarship must be claimed by September 15,2017.

• Recipient should check with a tax advisor re- garding the possible tax implications of this gift.

Selection Procedure• The AAA School Safety Patrol Scholarship

Committee in Michigan will determine thewinning recipients.

• AAA Michigan reserves the right to modify orterminate the AAA School Safety PatrolScholarship Program at any time.

• Children and family members of AAA Michiganand ACG employees, officers and board mem-

bers are not eligible (including grandchildren, nieces, nephews etc.).

All applicants must be a graduating high school senior from a public or parochial high school or private prepara-tory school within the service area of AAA Michigan. This includes reasonable and non-discriminatory rules and regulations as developed by the Committee and accepted by an institution of higher learning.

DocumentationAll applications must provide:

p A personal letter of introduction describing community involvement, extra-curricular activities and what being part of the AAA School Safety Patrol program has meant to you.

p A letter of recommendation from a school official AND a letter of recommendation from a community representative. Ex: teacher, counselor, principal, youth leader, employer or other.

p A copy of junior year transcript documenting a minimum 3.0 GPA.

p A copy of exam results of ACT with a minimum score of 21 or SAT with a minimum of 950.

p Proof of AAA School Safety Patrol participation in Michigan, verifying service in good standing; such as a letter from an elementary school principal, copy of AAA School Safety Patrol certificate, etc.

p Signature of parent/legal guardian and school counselor.

Guidelines• Applications must be postmarked on or before

May 12, 2017.• Applications are limited to one per school.• Applications are the property of AAA Michigan

and will not be returned.

Please provide the following information along with the documents listed in the Documentation section of this form.

AAA School Safety Patrol School:

____________________________________________ School Year Served:

____________________________________________ Name of college/institute applicant plans to attend:

____________________________________________Planned field of study:

____________________________________________ Signature of current principal/counselor:

____________________________________________Printed name of current principal/counselor:

____________________________________________

Date: ________________________________________

Please return this application to your school’s Counseling/Guidance Office no later than April 13, 2017. DO NOT send this to AAA. The school will be responsible for submitting their selected nominee application by May 12, 2017.

____________________________________________

For Counseling/Guidance Office use only: Send submissions to: Electronically (preferred method via scan/email): [email protected] or

Mail: AAA Michigan Public Affairs Department Scholarship Applications 1 Auto Club Drive Dearborn, MI 48126Questions/comments: [email protected]

Four $1,000 scholarships will be awarded to graduating seniors who served as AAA School Safety Patrol members in Michigan. Students must submit documentation of AAA School Safety Patrol participation, good academic standing and a strong record of participation in the community and extra-curricular activities.

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student information - dearborn high school · [email protected] or mail: aaa michigan ....

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