THE

DONALD W. DANIELSON

2010
MEMORIALFIREFIGHTER
SCHOLARSHIP
APPLICATION

TO: ALL GRADUATING SENIORS OF LAKE HAVASU CITY SCHOOLS FROM 2006-2010

FROM:DONALD W. DANIELSON SCHOLARSHIP COMMITTEE

REF:2010 SCHOLARSHIP APPLICATIONS

This scholarship allows us to honor the life and memory of Lake Havasu City firefighter Donald W. Danielson each and every year. As a LHHS graduate and Lake Havasu City firefighter, Don served his community with pride and professionalism. So it is with a sense of honor that we offer this scholarship in his name. This scholarship is exclusively available for students who are pursuing a career & education in the fire service or the emergency medical field. Applicants must have graduated from Lake Havasu High School, home school or LHC charter schoolsbetween 2006-2010and enroll in a Post-Secondary Institution in the fall of 2010. This application must be completed and returned to the Scholarship Committee Chairperson, Tony Rivello by April 16, 2010.

BE SURE YOU COMPLETE THE FOLLOWING BEFORE YOU SUBMIT YOUR APPLICATION!

  1. Please type or print clearly all information requested in the application.
  1. Please read the statement on the bottom of the application and sign. If you do not read and sign the waiver, you will not be considered for the scholarship.
  1. Forward application & recommendations to:

Mr. Tony Rivello

Scholarship Committee Chairman

LakeHavasu Professional Firefighters

P. O. Box 1515

Lake Havasu City, AZ86405

NOTE: AN INCOMPLETE AND/OR LATE APPLICATION WILL NOT BE CONSIDERED.

THE

DONALD W. DANIELSON

2010

MEMORIAL FIREFIGHTER

SCHOLARSHIP

APPLICATION

Due Date 4/16/2010

FOR MORE INFORMATION

CONTACT

MR. TONY RIVELLO

E-MAIL:

(PRINT OR TYPE CLEARLY)

APPLICANT’S NAME:

STREET/POSTAL ADDRESS:

CITY: STATE: ZIP:

PHONE: EMAIL ADDRESS:

PROGRAM MAJOR:

ANTICIPATED NUMBER OF CREDITS:

ENROLLMENT DATE: PROJECTED COMPLETION DATE:

INSTITUTION ATTENDING:

I authorizeLake Havasu CityHigh School to release my academic information for the purpose of scholarship selection. In addition, I authorize the scholarship committee to release information on announcing my scholarship for publicity purposes (i. e. hometown newspaper).

APPLICANT CERTIFICATION

I certify that the information provided in this scholarship application is correct to the best of my knowledge and that I will be enrolled as a full time student at the above listed educational institution.

SIGNED: DATE:

NON DISCRIMINATION STATEMENT

The DONALD W. DANIELSON scholarship committee assures the no person shall, on the grounds of race, color, national origin, creed, religion, gender, marital status, sexual preference, status with regard to public assistance, age, or disability be excluded from participation in or be denied the benefits of, or be otherwise subjected to discrimination while under consideration to receive a scholarship.

The scholarship committee considers the following information vital to your application. Please be sure to complete this section completely!

Page 1

REFERENCES: Please list the names of individuals from whom you will be seeking recommendations. Remember, you must submit three (3). References must include a combination ofindividuals who are aninstructor, employer, counselor, club advisor, pastor etc. Make certain these references are returned, as three are required for application consideration. All 3 can not be from the same category. (Please see last 3 pages of application)

1. Phone #

2. Phone #

3. Phone #

COMMUNITY INVOLVEMENT: List community groups, clubs and activities/experiences in which you have been involved. (Be specific)

1.

2.

3.

SCHOOL INVOLVEMENT: List activities in which you are involved in school. (Be specific)

1.

2.

3.

AWARDS/RECOGNITION: List any awards and/or recognition you have received during your youth. (Be specific- i.e. offices held, academic awards, community awards, scouts etc.)

1.

2.

3.

4.

Page 2

WORK EXPERIENCE: List any employment experiences you have. If it relates to the pursuit of your career please explain how. (Be specific)

PERSONAL STATEMENT:Please provide the selection committee a personal statement that includes the following: information about yourself, what accomplishments you consider significant thus far in your life, future goals have you established for yourself and why you consider yourself the most qualified applicant for the scholarship. (You may use additional space and/or pages if needed.)

Page 3

PLEASE RESPOND TO THE FOLLOWING QUESTIONS:

1. What is your current financial situation? (For example, are you living on your own with no financial assistance from your parents? Do you have any dependents for which you contribute support? Address other factors affecting your financial situation at this time.)

2. Do you have any loans for which you are financially responsible?

Yes No If yes, check loan balance, which applies.

$ 0 –499, $500 – 999, $1000 – 1999, $2000 – 2999, $3000 +

3. If you have a job, how many hours do you work per week?

1 to 7 hrs, 8 – 15 hrs, 16 to 29 hrs, 30 plus,

4. Are you responsible for monthly expenses while in school (under 18 and living at home)? If yes, check the amount that applies.(MONTHLY)

$ 50, $ 100, $150, $200, $250, _____ $250+

5. Will you be a “Non-Traditional” Student? Yes No

A Female in a traditionally Male dominated program.

A Male in a traditionally Female dominated program.

Application Checklist:

  1. Complete application
  2. Sign applicant certification (page one).
  3. Three (3) recommendations submitted.
  4. Personal statement completed.
  5. Financial information completed.
  6. Follow-up with recommendations to make certain all 3 are turned in.
  7. Include copy of transcript, diploma and/or GED.

THIS INFORMATION IS KEPT CONFIDENTIAL!

IF YOU AGREE TO COMPLETE THIS FOR A STUDENT PLEASE MAKE CERTAIN YOU RETURN IT AS APPLICATION COMPLETION IS DEPENDENT ON THEM.

DONALD W. DANIELSON

SCHOLARSHIP RECOMMENDATION

STUDENT’S NAME DATE

Please give your recommendation of the student’s qualifications by circling the number in each of the seven categories, which best represents, the student’s abilities.

Student PerformanceSuperior / Above-Average / Average / Below Average

1. Class work (if applicable) 4 3 2 1

2. Quality of work (school or job) 4 3 2 1

3. Cooperation 4 3 2 1

4. Initiative (work without supervision) 4 3 2 1

5. Judgment (consider the ability for 4 3 2 1

sound decisions)

6. Leadership (people skills) 4 3 2 1

7. Dependability (consider reliability, 4 3 2 1

attendance.)

ADDITIONAL COMMENTS:

Signature Title

Relationship to Student:

Please forward this recommendation directly to:

Mr. Tony Rivello

P.O. Box 1515

Lake Havasu City, AZ86405

THIS INFORMATION IS KEPT CONFIDENTIAL!

IF YOU AGREE TO COMPLETE THIS FOR A STUDENT PLEASE MAKE CERTAIN YOU RETURN IT AS APPLICATION COMPLETION IS DEPENDENT ON THEM.

DONALD W. DANIELSON

SCHOLARSHIP RECOMMENDATION

STUDENT’S NAME DATE

Please give your recommendation of the student’s qualifications by circling the number in each of the seven categories, which best represents, the student’s abilities.

Student PerformanceSuperior / Above-Average / Average / Below Average

1. Class work (if applicable) 4 3 2 1

2. Quality of work (lab assignments) 4 3 2 1

3. Cooperation 4 3 2 1

4. Initiative (work without supervision) 4 3 2 1

5. Judgment (consider the ability for 4 3 2 1

sound decisions)

6. Leadership (people skills) 4 3 2 1

7. Dependability (consider reliability, 4 3 2 1

attendance.)

ADDITIONAL COMMENTS:

Signature Title

Relationship to Student:

Please forward this recommendation directly to:

Mr. Tony Rivello

P.O. Box 1515

Lake Havasu City, AZ86405

THIS INFORMATION IS KEPT CONFIDENTIAL!

IF YOU AGREE TO COMPLETE THIS FOR A STUDENT PLEASE MAKE CERTAIN YOU RETURN IT AS APPLICATION COMPLETION IS DEPENDENT ON THEM.

DONALD W. DANIELSON

SCHOLARSHIP RECOMMENDATION

STUDENT’S NAME DATE

Please give your recommendation of the student’s qualifications by circling the number in each of the seven categories, which best represents, the student’s abilities.

Student PerformanceSuperior / Above-Average / Average / Below Average

1. Class work (if applicable) 4 3 2 1

2. Quality of work (lab assignments) 4 3 2 1

3. Cooperation 4 3 2 1

4. Initiative (work without supervision) 4 3 2 1

5. Judgment (consider the ability for 4 3 2 1

sound decisions)

6. Leadership (people skills) 4 3 2 1

7. Dependability (consider reliability, 4 3 2 1

attendance.)

ADDITIONAL COMMENTS:

Signature Title

Relationship to Student:

Please forward this recommendation directly to:

Mr. Tony Rivello

P.O. Box 1515

Lake Havasu City, AZ86405