Robert Joseph "Josh" Dormagen, II Scout Leadership Award

Personal Information: Phone Number: ____________ Email Address: ________________________________________

 

Last Name: ___________________________   First Name: ____________________ Middle Name: _________________

 

Home Address: ____________________________________________________________________________

 

Parents Name: _____________________________________________________________________________

 

Academic Information: Name of High School you attend: ____________________________________________

 

Class Rank: ____ of _____   Cumulative GPA: ______   SAT Combined Score: _______   ACT Score: ________

 The above information is certified by the Guidance Office at your High School:

 Counselor Signature: ________________________________                     Date: _______________

 Counselor Print Name: _______________________________       

Scouting: Are you currently a registered Scout? _____     Most recent Troop or Venture Crew number: _____

have been accepted to attend the following colleges (universities)

__________________________________________      _____________________________________________

__________________________________________      _____________________________________________

Extracurricular Activities: Show years of involvement, indicate leadership positions held for the following:
Boy Scouts of America – list on separate sheet
Academic Honors and Other Awards – list on separate sheet
Other Organizations and Clubs – list on separate sheet
Employment Experiences – list on separate sheet

 

Scouting

On an attached sheet explain in 100 words or less (typed) describe how Scouting has influenced your life.

The Future

On an attached sheet explain in 100 words or less (typed) your future educational and life goals. 

 

**********

 I have read the foregoing application, and the information set forth therein is true and accurate.  The award deadline is April 1st.

 

Applicant’s Signature______________________________________________         Date __________________

 

Application must be typed or neatly printed. Application should be mailed or presented to:

            The Josh Dormagen Scout Leadership Award
   % David Harling
            9701 McQueen Road
            Laurinburg, N.C. 28352