CLEMENT A. DURAN YOUTH PARTICIPANT SCHOLARSHIP AWARD APPLICATION
This form must be filled out by the district coordinator or their representative.

CLEMENT A. DURAN YOUTH PARTICIPANT SCHOLARSHIP AWARD CRITERIA :

Award application Deadline: Preferred January 30, 2017, absolute deadline March 11, 2017

Youth Participant (Clement A. Duran Memorial Awards)
 A senior in High School
 Participation in the Youth & Government program for a minimum of two years
 A participant who has exemplified the conduct expected as spelled out in the Code of Conduct
 Leadership involvement in local community and the Youth & Government program
 Qualify as a participant to the Youth & Government Spring Leadership Conference
 Assure the State Executive Committee that the award will be used for educational expenses.
 The cash award is presented at the closing banquet of the State Conference, contingent on supportive funding from the NY State YMCA Foundation.
 Some consideration is given to financial need.

First Name of Nominee *
Your answer
Last Name of Nominee *
Your answer
Phone Number *
Your answer
Address
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
District *
Your answer
School
Your answer
YMCA
Your answer
E-Mail *
Your answer
Number of Years in Youth And Government
Your answer
Positions (Offices held, honors/awards received in Youth & Government)
Your answer
In the space below list all extra-curricular school activities, volunteer, community, church and other YMCA involvement. After each item listed, indicate the approximate number of hours spent on that activity each week and briefly explain what their participation involved (leadership roles, offices/awards, specific function, special projects…etc.) *
Your answer
CHOOSE ONE OPTION: Option A: In an essay: (attach sheets) Choose one specific experience your student’s participation in Youth & Government, explain the significance of that one experience, how it affected him/her and why you single out that particular experience. Option B: In an essay: How do you think your student’s participation in the Youth & Government will affect his/her future? *
Your answer
Advisor Name *
Your answer
District Coordinator *
Your answer
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This form was created inside of Kentucky YMCA Youth Association.