Learning to Serve Student Scholarship Application
Email address *
First Name *
Last Name *
Address *
City *
State *
Postal Code *
Birth Date *
MM
/
DD
/
YYYY
Parent/Guardian Name *
Parent/Guardian Email Address *
Phone Number (xxx-xxx-xxxx) *
Family Adjusted Gross Income (most recent tax filing)* *
*Note: This information is not used to determine eligibility. However, it is required for reporting scholarship demographic data to the GA Dept. of Revenue.
Number of Dependents* *
*Note: This information is not used to determine eligibility. However, it is required for reporting scholarship demographic data to the GA Dept. of Revenue.
Current School Attending *
Current Grade *
School to Attend for 2020-2021
Eligibility
To qualify for this program:
1. Student must be a Georgia resident.
2. Student must meet the State eligibility requirements located on the Georgia Department of Education website. (www.doe.k12.ga.us)
3. Student must complete an essay explaining your service experience.
Student Signature *
In submitting these materials, I certify that all of the information submitted in support of my application is complete and accurate to the best of my knowledge. False information will result in termination of the scholarship if granted.
Parent/Guardian Signature *
I certify that the information provided by the applicant is complete and accurate to the best of my knowledge.
School Certification *
Name, Email and Phone Number for School Official
Student Service Qualification
Each student is asked to submit an essay detailing their service experience, including a description of service, hours served, and lessons learned. The essay should be appropriate in length as determined by the student’s age.

The student’s essay must include:
* A full description of the service provided
* A description of the benefits provided
* A description of the individuals who benefited from the service
* A narrative description, in the student's own words, of what benefits they personally experienced in providing the service and what benefits they believe the recipient of the service enjoyed.
* A description of anecdotes and personal experiences that demonstrate the personal effect the service had on the student. How did the experience affect the student and develop the student’s character?
Student Service Summary/Essay *
A copy of your responses will be emailed to the address you provided.
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