Jack and Jill of America, Inc., Suffolk County Chapter
Kathleen Taylor Memorial Community Service Scholarship
2016 Application
Name of Applicant____________________________________________________________________
Address_________________________________City____________________State_____Zip________
Phone (home) ____________________________(cell)_______________________________________
Email Address_______________________________________________________________________
Name of High School_________________________________________________________________
Parent/Guardian______________________________________________________________________
Current GPA_________________________ Gender: Female_____________ Male_______________
Community Service Activities: Please list activities by year (ex. 9th grade, 10th grade, etc.) Be specific. List the date of the activity, the number of hours and the location of the community service activity. Indicate if the community service was part of a class/club or done independently. (Feel free to attach separate or additional sheets, if necessary)
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Extracurricular Activities: Please indicate your grade and duration of involvement. (Feel free to attach separate or additional sheets, if necessary)
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Essay : Topic – What Community Service Means to You (attach a typewritten essay of at least 500 words). Please include your Name and High School on attached typewritten sheet.
Applicant Signature : ______________________________________ (Please sign to indicate that you have read and meet all the requirements for this scholarship).
Deadline is April 1, 2016
***See back of application for requirements
Requirement s for the Kathleen Taylor Community Service Scholarship:
1. Student of African Ancestry (African, African-American, and Caribbean American) who is a Suffolk County high school senior at a public High School may apply for the scholarship.
2. Scholarship applicants must have GPA of 3.0 or better.
3. Scholarship applicants must plan on seeking a Baccalaureate Degree.
4. Applicants are required to submit:
a. Completed, signed application
b. One letter of recommendation (teacher, guidance counselor, community leader, etc.)
c. Current transcript
d. Typed essay (minimum of 500 words) Topic: What Community Service Means to You .
5. Application must be postmarked by April 1, 201 6.
6. Applications should be mailed by the deadline to:
Mrs. Mireille Lubin
Jack and Jill of America, Inc.,
Suffolk County Chapter Scholarship Committee
7 Stonywell Court
Di x Hills, New York 11746
7. If you have any questions, please feel free to call at 631-682-2641.