Charlie Cook Memorial Scholarship Application Deadline 4/12/16 Name:______________________________ Date of Birth:_________________ Address:____________________________ H.S./Grade:___________________ City:___________________________________ State:_________ Zip:_______________ Elks Lodge or Fire Department parent is a member of:______________________________ 1) List all community service organizations you have been affiliated with and length of time you have been a member. Organization Years __________________________________________ _________ __________________________________________ _________ __________________________________________ _________ __________________________________________ _________ 2) List all extra curricular activities/sports: 3) Applicants must write a single sided, two page double spaced essay describing your unique community service activities. Discuss in detail how you contribute to helping your community, why is community service important to you, what you have learned from your experiences and how you plan on continuing to your service in the future. 4) Please include (1) letter of recommendation from a teacher and (1) letter of recommendation from an adult affiliated with any of your community service organizations. 5) Include documentation from your high school listing your current G.P.A. (must be 2.0 or higher). 6) Please submit this application along with your essay and other required documentation to your high school guidance counselor no later than April