A.G. TERRY SHAFFER MEMORIAL CITIZENSHIP AWARD (due April 1, 2021)
A $1,000.00 A.G. Terry Shaffer Memorial Citizenship Award is presented annually by the Kiwanis Club of Northwest Indianapolis to a Brebeuf Jesuit High School senior student who best demonstrates good school, family and community citizenship.

Terry Shaffer devoted much of his life to service as a member of the Kiwanis family. He was active in all levels of the organization, as a leader in both the Pennsylvania and Indiana districts and, from 1969 to 2004, as a member of the Kiwanis International staff. But Terry was most passionate about his Kiwanis involvement at the local level. A native of Sudbury, Pennsylvania, he was a member and treasurer of the Sunbury High School Key Club. He served as both president and secretary of three Kiwanis clubs, including Northwest Indianapolis.
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For the application to be complete, these two additional items need to be emailed to johnshertzer@gmail.com: (1) unofficial transcript, and (2) one (only one) written recommendation from one member of your school’s faculty or staff.
Applicant’s Name: *
Applicant’s Address: *
Applicant’s Phone Number: *
Applicant’s Email : *
Please submit typewritten responses of 100 to 150 words for each of the criteria below.
Citizenship in the school: How have you shown respect for self and others, is a good member and/or leader in school activities such as sports, student government and service organizations?
Citizenship in the home: Describe how you have demonstrated respect and involvement within your family.
Citizenship in the community: How have you shown respect for the Indianapolis community? Describe activities have you initiated, led or taken part in to make this a better place in which to live.
Academic achievement: Describe how you have performed in the classroom at a level consistent with or above one’s ability. In addition, provide a copy of your academic transcript (email to address listed above).
Are you a Key Club Member? (Key Club membership is not necessary to be considered for this scholarship)
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(If YES to the prior question) Key Club involvement: How have you served your family, school, place of worship and/or community through your involvement in Key Club? Describe your involvement in specific projects.
Describe one citizenship goal you have for yourself in the next 12 months:
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