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2023 Jason Vitale Community Service Award Application Cover Page
Interested high school students should submit the cover page below and email additional application materials to baldwincivic@gmail.com.  
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Email *
Name
Age
Date of Birth
MM
/
DD
/
YYYY
Mailing Address
Daytime Phone Number
Email Address
High School Name
Guidance Counselor Name
High School Average
Favorite Subject
College/School or Program Name
College/School Annual Tuition Cost
1. What is your intended major and future occupation?
2. List two activities/clubs that you belong to in school or community
3. How will this scholarship help you in your college career?
Parent/Guardian First Name
Parent/Guardian Last Name
Paren/Guardian Phone Number
Parent/Guardian Email
Applicant Disclosure (Type Your Name Below): I attest that all of the information provided in this application is complete, factually correct and honestly presented. I understand that if any of the information is found to be false, this may result in disqualification of the scholarship award. I understand that it is my responsibility to submit appropriate bills to the Baldwin Civic Association for payment.
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