AMES AND ELLIOTT SCHOLARSHIP

Scholarship Award Application

General Information and Criteria

The Brentwood Fire Department is pleased to announce the availability of two (2) scholarships to members of the Brentwood Fire Department and its Department Honorary families. All High School applicants must be an immediate family member of the Brentwood Fire Department/ Department Honorary.

Applications will be available from the Brentwood Fire Department website (Error! Hyperlink reference not valid.).

Criteria for Selection

  1. The recipients must be continuing on to further education at a two (2) or four (4) year accredited college or university;
  2. The two scholarships will be awarded to graduating high school seniors as follows:
  1. Four year average of 90 or better in High School(transcript to be provided);
  2. Fifty (50) hours of Community Service;
  3. Three Extra curriculum Activities or Honor Classes;
  4. Minimum of 1000 word essay on how the individual student best portray the attributes of Martin Ames and Charles Elliot;
  1. Awards will be made be made directly to the accredited college/university upon proof of registration;
  2. Applicants will be evaluated by a committee appointed by the Ames and Elliot Scholarship Committee. All decisions made by the committee are final;
  3. Recommendation Requirements:

High School Seniors;

  1. (2) Teachers Recommendations;
  2. (1) Guidance Counselor Endorsement;
  3. (2) Personal Recommendation;
  4. (1) Proof of Department Membership.
  1. All applications must be postmarked by June 3, 2013. Mail all applications to the Brentwood Fire Department, Ames and Elliot Scholarship Committee, located at 125 Fourth Street, Brentwood, New York 11717.

ALL INFORMATION IS CONFIDENTIAL AND FOR USE BY THE

AMES AND ELLIOT SCHOLARSHIP COMMITTEE

AMES AND ELLIOT SCHOLARSHIP

  1. Applicant’s Name: Date of Birth:
  2. Address:
  3. Telephone No.:
  4. Parent’s Name:
  5. Parent’s Address:
  6. College or University Attending:
  7. Major Area of Study:
  8. List any community organizations of clubs that you have been a member of and

the length of involvement:

  1. List three (3) extracurricular activities and/or honor classes:
  2. Name and addresses of Community service provided:

AMES AND ELLIOT SCHOLARSHIP

Scholarship Award Application

Guidance Counselor Endorsement

  1. Applicants Name:
  2. Guidance Counselor’s Name:
  3. Guidance Counselor’s Signature:
  4. High School:
  5. Number of years as a Guidance Counselor:
  6. Please describe the applicant’s involvement and accomplishments in school and community activities under your guidance. We would be particularly interested in how he/she related to other students, faculty, administration and other support personnel. If there is other information that you feel might help the selection committee, please feel free to comment. Use space below or attach recommendation to this form.

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AMES AND ELLIOT SCHOLARSHIP

Scholarship Award Application

Teacher’s Recommendation

  1. Applicants Name:
  2. Teacher’s Name:
  3. Teacher’s Signature:
  4. High School:
  5. Number of years as a Teacher:
  6. Please describe the applicant’s involvement and accomplishments in your class. We would be particularly interested in how he/she related to other students, faculty, administration and other support personnel. If there is other information that you feel might help the selection committee, please feel free to comment. Use space below or attach recommendation to this form.

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AMES AND ELLIOT SCHOLARSHIP

Scholarship Award Application

Personnel Reference

This form is to be completed by a person who is not:

A relative of the applicant;

A high school or college level teacher of the applicant;

A member of the applicant’s high school administration;

A member of the applicant’s local fire department of district

  1. Applicant’s Name:
  2. Your Name:
  3. Signature:
  4. Address:
  5. Telephone Number:
  6. Occupation:
  7. Employer/Firm:
  8. How long have you known the applicant:
  9. Please briefly describe the nature of your acquaintance with the applicant and any personal traits and qualities that you consider exceptional or outstanding. If there is other information that you feel might help the selection committee, please feel free to comment. Use space below or attach recommendation to this form.

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AMES AND ELLIOT SCHOLARSHIP

Scholarship Award Application

Proof of Membership

  1. Applicant’s Name:
  2. Member’s Name:
  3. Date of Member’s Entry: Date of Resignation:
  4. Company: Year of Honorary Status: