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STUDENT INFORMATIONStudent's Full Name (Please Print or Type)

Application For The Scholarship Of Honor™Application For The Scholarship Of Honor™

More than 50 million brave young men and women have served our country in uniform with honor. As proud Americans we salute their efforts. We look for ways to instill in others the pride and determination of those who gave so much of themselves for others and most of all, we have made a vow to remember. In an effort to always remember their courage and patriotism, the Brian LaViolette ScholarshipFoundation honors them with the Scholarship of Honor. Our goal, and those who contribute to this Scholarship of Honor program, is to assist you as you follow your aspirations. This scholarship recognizes a graduating high school senior with plans to enlist in the military or pursue a career in public safety or community service. (fire safety, police science, teaching, nursing, EMT, ministry, and other noble causes.) Remember and believe as Brian did...

To Honor, To Remember, Those Who Serve

Return to Guidance Officeby March 30th

ACTIVITIESNote those activities in which you have been actively engaged (organizations, sports, or clubs) and which you feel have been most meaningful to you (include years of participation, grade, levels, and any offices held). If you need additional space, please add another sheet

WORK EXPERIENCEList employment you have held in the past three or four years. You may use additional sheets if necessary.

Position Employer

During the Summer or School Year Dates

Number ofHours Per

Week

HIGHER EDUCATION, PUBLIC SERVICE AND MILITARY INFORMATION

If applicable, the College or University you have been accepted to:

What field of study?

If applicable, the Branch of the Armed Forces you have been accepted to:

Anticipated enrollment, or enlistment date:

ESSAYIn a short essay, share why you believe you are deserving of a scholarship and how will you use your talents to make a difference in your community or this world. The essay must be typed and NO MORE THAN 500 WORDS.

The SCHOLARSHIP OF HONOR recipient will receive a cash award as well as a specially designed SCHOLARSHIP OF HONOR medal during a public ceremony. Should you receive this scholarship, you are encouraged to stay in contact with the LaViolette Foundation and the sponsor of this award.

REFERENCESLetters of reference are not required. However, at least one reference and no more than two references of the applicant’s choice should be named. The selection committee reserves the right to contact these references. References cannot be family members or peers.

Name Phone

Name Phone

DUE DATETurn into the guidance office by March 30th, unless otherwise stated by the guidance office.

I certify that all the above information is true to the best of my knowledge.

Signature of Student

Date

Name of Scholarship/Grant Amount You Will Receive

FAMILY INFORMATION

Parents: (Check if living)

( ) Father ( ) Stepfather ( ) Student has legal guardian:

( ) Mother ( ) Stepmother (Name)

( ) Parents Divorced ( ) Parents Separated

Number of Children in Family # Brothers #older # younger

Number who will be in college # Sisters #older # younger

Date Signature of Student

Have you been awarded (or reasonably expect to receive) other grants or scholarships? ( ) Yes ( ) No

If yes, please complete the section below.

Grade Point Average (GPA)—High School:

Number of Students in Class:

Rank in Class—High School:

SCHOOLINGList in chronological order all schools attended in the last four years, including any summer or special courses.

Name of School Location (city) Dates of Attendance

List any academic distinction or honors you have earned and the grade levels in which you earned them (9, 10, 11, 12).You may use additional sheets if necessary.

ACTIVITIESNote those activities in which you have been actively engaged (organizations, sports, or clubs) and which you feel have been most meaningful to you (include years of participation, grade, levels, and any offices held). If you need additional space, please add another sheet

WORK EXPERIENCEList employment you have held in the past three or four years. You may use additional sheets if necessary.

Position Employer

During the Summer or School Year Dates

Number ofHours Per

Week

HIGHER EDUCATION, PUBLIC SERVICE AND MILITARY INFORMATION

If applicable, the College or University you have been accepted to:

What field of study?

If applicable, the Branch of the Armed Forces you have been accepted to:

Anticipated enrollment, or enlistment date:

ESSAYIn a short essay, share why you believe you are deserving of a scholarship and how will you use your talents to make a difference in your community or this world. The essay must be typed and NO MORE THAN 500 WORDS.

The SCHOLARSHIP OF HONOR recipient will receive a cash award as well as a specially designed SCHOLARSHIP OF HONOR medal during a public ceremony. Should you receive this scholarship, you are encouraged to stay in contact with the LaViolette Foundation and the sponsor of this award.

REFERENCESLetters of reference are not required. However, at least one reference and no more than two references of the applicant’s choice should be named. The selection committee reserves the right to contact these references. References cannot be family members or peers.

Name Phone

Name Phone

DUE DATETurn into the guidance office by March 30th, unless otherwise stated by the guidance office.

I certify that all the above information is true to the best of my knowledge.

Signature of Student

Date

Name of Scholarship/Grant Amount You Will Receive

FAMILY INFORMATION

Parents: (Check if living)

( ) Father ( ) Stepfather ( ) Student has legal guardian:

( ) Mother ( ) Stepmother (Name)

( ) Parents Divorced ( ) Parents Separated

Number of Children in Family # Brothers #older # younger

Number who will be in college # Sisters #older # younger

Date Signature of Student

Have you been awarded (or reasonably expect to receive) other grants or scholarships? ( ) Yes ( ) No

If yes, please complete the section below.

Grade Point Average (GPA)—High School:

Number of Students in Class:

Rank in Class—High School:

SCHOOLINGList in chronological order all schools attended in the last four years, including any summer or special courses.

Name of School Location (city) Dates of Attendance

List any academic distinction or honors you have earned and the grade levels in which you earned them (9, 10, 11, 12).You may use additional sheets if necessary.

IN TRIBUTE TO…

Army Congressional Medal of Honor Recipients Ken Stumpf (top) and Elmer Burr (bottom), who both attended Menasha High School and were awarded our Nations highest honor for bravery. Sponsor: Guy J. Smith, Suburban Electrical Engineers/Contractors Inc. Navy Corpsman John Bradley WWII Iwo Jima Navy Cross Recipient, Appleton West High School, WI. Sponsor: Weyers Family Foundation

Army Sgt. Mike Colalillo Medal of Honor Recipient, Denfeld High School, Duluth, MN. Sponsor: Guy J. and Karen R. Smith

SCHOLARSHIP OF HONOR™

www.briansjourney.comKim LaViolette 828.242.3790 kim.laviolette@gmail.com

Army Spc 4 Nichole Marie Frye Lena High School, class of 2002. Lost February 16, 2004. Sponsor: Associated Bank

Marine Cpl. Jesse Thiry Luxemburg Casco High School, class of 2000. Lost April 5, 2004. Sponsor: Whetter Law Offices

Marine Pfc. Ryan Jerabek Pulaski High School, class of 2003. Lost April 6, 2004. Sponsor: Premier Community Bank

Army Pfc. Isaiah Hunt Bayport High School, class of 2002. Lost November 15, 2004. Sponsor: Omnova Solutions Foundation, Green Bay, WI

Marine Sgt. Benjamin Edinger Green Bay West High School, class of 1999. Lost Nov 23, 2004. Sponsor: WNFL Maino and Nick Show

Marine Lance Cpl. Brent Vroman Omro High School, class of 2001. Lost Dec 13, 2004. Sponsor: John & Kathy Lochner Family

IN HONOR AND MEMORY OF THOSE WHO MAKE THE ULTIMATE SACRIFICE…

Army Spc. Kyle Hemauer Chilton High School, class of 2002. Lost May 23,2005. Sponsor: Community of Chilton, Wisconsin

Marine Cpl. Andrew Brownfield North High School, Akron, OH Lost March 18, 2004. Sponsor: Omnova Solutions Foundation, Fairfield, OH

Army Sgt. Kenneth D. Hess Reynolds High School, Asheville, NC. Lost April 11, 2006. Endowment sponsor drive underway.

Marine Sgt. Eric McColley Gettysburg High School, Gettysburg, PA. Lost February 17, 2006. Sponsor: Community of Gettysburg, Pennsylvania

Marine Lt. James Cathey Reno High School, Reno, NV. Lost August 21, 2005. Sponsor: Remembering The Brave Foundation

Marine Cpl. Joe Welke Stevens High School, Rapid City, SD. Lost November 20, 2004. Sponsor: Friends of Joe Welke

Navy Seal Danny Dietz Heritage High School, Littleton, CO, class of 1999. Lost June 28, 2005. Sponsor: The Mader Family

Army Lt. Nainoa Hoe Kamehameha Schools, Honolulu, HI, class of 1995. Lost January 22, 2005. Sponsor: Ohelo Kaopio

Air Force 1st Lt. Joel GentzPurdue University, ROTC program. Lost June 9, 2010. Sponsor: John and Kathy Lochner Family

Army Pfc. Rachel BosveldWaupun High School, Waupun, WI. class of 2002Lost October 26, 2003. Sponsor: Bob and Darlene Nueske

Marine Sgt. Jerome HatfieldTunstall High School, Brosville, VA, class of 1991. Lost July 11, 2009. Endowment sponsor drive underway.

Army Sgt. Leonard Keller Medal of Honor Recipient, Auburn High School, Rockford, IL. Endowment sponsor drive underway.

Army LTG Robert Foley Medal of Honor Recipient, United States Military Academy at West Point Sponsor: Brian LaViolette Foundation

Navy Pilot Thomas Hudner Medal of Honor Recipient, Wisconsin Wing Civil Air Patrol Sponsor: Brian LaViolette Foundation

Army Combat Medic Ron L. Sager Combat Medical Badge and the Vietnamese Cross of Gallantry, Fox Valley Lutheran High School. Sponsor: Fox Valley Vietnam Veterans Association

George S. Patton III Commanding General 3rd Army Pilsen, Czech Republic Endowment sponsor drive underway.

Army SSG Sal GiuntaMedal of Honor Recipient John F. Kennedy High School Cedar Rapids, IA Endowment sponsor drive underway. In memory of Sgt. Josh Brennon and SPC Hugo Mendoza

In 1992, Brian LaViolette died in a swimming accident at the age of 15. Brian’s bold sense of community service led to the creation of the Brian LaViolette Scholarship Foundation which allows others to fulfill his goals and dreams. We see now in these brave young men and women the same sense of community pride that reminds us of Brian’s commitment and spirit. The Scholarship of Honor is awarded to a young man or woman who will be entering the a career in public safety or community service or the U.S. Armed Forces, immediately upon graduating from high school.

Annual Scholarship of Honor awards are presented in the names of the following:

Brian LaViolette1977-1992

To Honor, To Remember, Those who serve.