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A P P L I C A T I O N IF YOU’VE MADE A DIFFERENCE, WE WANT TO HEAR ABOUT IT. T H E 2 0 0 7 P R U D E N T I A L S P I R I T O F C O M M U N I T Y AWA R D S HONORING MIDDLE AND HIGH SCHOOL STUDENTS FOR VOLUNTEER SERVICE IN THEIR COMMUNITIES A P P L I C AT I O N D E A D L I N E : O C T O B E R 3 1 , 2 0 0 6 2007 Prudential Spirit of Community Awards Application (Photocopy if additional copies are needed) INSTRUCTIONS — Application must be filled out by applicant. Please read all instructions before completing this form. 1. Make sure you’re eligible. Applicants must: * be individuals enrolled in grades 5-12. Groups and partners are not eligible. * be a legal resident of one of the 50 states of the United States or the District of Columbia. * describe a volunteer community service activity performed at least in part after September 1, 2005. * not be employees of NASSP, Scholarship America, Prudential or its affiliates; their children; or previous National Honorees. Previous State Honorees are eligible only if their submitted activities are significantly different from previously honored activities. 2. Fill out this application form completely and accurately in your own words in the space provided. Do not attach additional sheets. * Use a computer, typewriter or black ballpoint pen (if using a computer, tape or paste each answer in at least 10-point type beneath its question). * Applications must be written in English or translated into English prior to submission for state-level judging. * Applications filled out by a parent or other adult will be disqualified. * All information provided is subject to verification. False, inaccurate, illegible, incomplete or reformatted applications will be disqualified. 3. Submit one fully completed application and one copy by October 31, 2006, to a school principal or to the head of one of these officially designated local organizations: a Girl Scout council, county 4-H organization, YMCA, American Red Cross chapter, or member Volunteer Center of the Points of Light Foundation & Volunteer Center National Network. * Applications sent to the state-level judging committee without first being submitted to a school or officially designated local organization are ineligible. * Applicants who receive state-level awards will be notified in February 2007 through the individuals who certified their applications. State Honorees and Distinguished Finalists also will be posted at www.prudential.com/spirit and www.principals.org/prudential. APPLICANT INFORMATION Last name Applicant’s name First name Street (no P.O. boxes) Home address __ Male __ Female Applicant’s phone Please print clearly. City County (not Country) Date of birth (month/day/year) ____/____/____ ( ) Middle initial State Zip Circle grade for 2006/07 school year: 5 6 7 8 9 10 11 12 Applicant’s e-mail address Name School you currently attend City State Names of parents/guardians Parent/guardian work phone ( ) Fax ( ) ACTIVITY SUMMARY Briefly answer the following questions within the space provided (no additional sheets), then provide more detail in the following sections. What was your volunteer community service activity? How did you become involved in this activity? What role did you play in the activity? Approximately how many hours did you spend on the activity? ❑ 0-49 ❑ 50-74 When did you start working on the activity (month/year)? ❑ 75-99 ❑ 100-174 ❑ 175-249 ❑ 250+ When did it end (month/year)? How did your activity impact others? Which of these categories best describes your activity? ❑ healthy communities ❑ youth achievement ❑ public safety / emergency response page 1 of 4 ❑ environment / parks / open spaces INSPIRATION Briefly explain what motivated you to do your volunteer work. How did you come up with the idea for your activity? Who or what inspired you to get involved? How did your volunteer activity begin? Why did you feel it was important? EFFORT Briefly explain the effort required to do your volunteer work. What exactly did you do, and how did you do it? What steps did you have to take to accomplish your goal? Did you recruit others to help, or work with any local or national organizations? If yes, explain. What was the most difficult part of your activity? page 2 of 4 IMPACT Briefly describe what your volunteer activity accomplished. Who benefited, and how? How many people were involved or directly affected? If your activity involved fundraising, how much was raised? Will your project continue in the future? PERSONAL GROWTH Briefly describe what you, yourself, got out of your volunteer work. What did you learn from your experience? Did you acquire any new skills? What was the most memorable part of this activity? Can you recall a specific incident that made you feel particularly good about volunteering? What would you tell other young people about your experience? page 3 of 4 APPLICANT AGREEMENT To be completed by applicant and parent/guardian. We certify that all information contained in this application is true and factual. We also agree that if applicant is selected as an honoree in The Prudential Spirit of Community Awards program, NASSP and Prudential may use applicant’s name and likeness and any other information or materials provided by applicant in connection with this program, including his/her resume, photograph(s) and videotape(s), for purposes of news, publicity and advertising in all media, including print, photographs, videotapes and electronic media, including but not limited to, Internet Web sites and CD-ROMs. We understand that in order to receive state and national awards, selected State Honorees are expected to attend the entire all-expense-paid national recognition events in Washington, D.C., May 5-8, 2007. Signature of Applicant Date Signature of Parent/Guardian Date Please indicate if applicant belongs to these or other youth or service organizations: ___ Girl Scouts ___ Boy Scouts ___ 4-H ___ Red Cross ___ YMCA ___ Volunteer Center ___ Key Club Other: REQUIRED CERTIFICATION If this application has been selected to advance to state-level judging, it must be certified below by (please check whichever applies): ___ a school principal ___ a Girl Scout council CEO ___ a county 4-H agent ___ an American Red Cross chapter executive officer ___ a YMCA executive director ___ an executive director of a member Volunteer Center of the Points of Light Foundation & Volunteer Center National Network Instructions to Certifier: You may submit one middle level Local Honoree for every 1,000 students or members (or portion thereof) in grades 5-8 and/or one high school Local Honoree for every 1,000 students or members in grades 9-12. If this application is for a Local Honoree whom you have selected to advance to state-level judging, complete and sign this page, and send this entire original application (pages 1-4) plus one copy postmarked no later than November 7, 2006 to: Prudential Spirit of Community Awards, State-Level Judging Committee, One Scholarship Way, P.O. Box 297, St. Peter, MN 56082. You do not need to complete this section for applicants whom you do not select as your Local Honoree(s). Please print clearly. Certifier’s name ___ Mr. ___ Ms. ___ Dr. Last name First Name Name of school or organization Address Street Telephone number ( ) City Fax number ( ) State Zip E-mail address How many middle level students (5th-8th grades) are enrolled in or affiliated with your school or organization? How many high school students (9th-12th grades) are enrolled in or affiliated with your school or organization? Important: How many students in your school or organization completed applications for this award? REQUIRED SIGNATURE To be completed by Certifier. I certify that the individual named in this application has been selected as a Local Honoree to represent this school or organization. Signature Date ESSENTIAL INFORMATION The following information is essential if your Local Honoree is selected as a State or National Honoree. The local newspaper(s) serving this community are: The network television stations serving this community are: If your school, district or organization has a public relations and/or community service director, please provide the following: Phone ( Name ) Has a Prudential representative been in contact with you in connection with this program? Fax ( ___ Yes Phone ( If yes: Name ___ No ) Attention Certifier: Send selected application(s), plus one copy, postmarked by November 7, 2006, to: The Prudential Spirit of Community Awards State-Level Judging Committee PLEASE REMEMBER TO MAKE A COPY One Scholarship Way OF YOUR LOCAL HONOREE’S APPLICATION P.O. Box 297 FOR YOUR FILES! St. Peter, MN 56082 To confirm receipt, you may paper clip a self-addressed, stamped postcard to this application. WE CANNOT CONFIRM RECEIPT BY TELEPHONE. If you have questions, visit www.prudential.com/spirit or www.principals.org/prudential, or call (888) 450-9961. page 4 of 4 ) T H E 2 0 0 7 P R U D E N T I A L S P I R I T O F C O M M U N I T Y AWA R D S What are The Prudential Spirit of Community Awards? More than 70,000 young people have been The Prudential Spirit of Community Awards were created in 1995 to recognize students in middle and high school grades who have demonstrated exemplary community service. These prestigious awards, sponsored by Prudential Financial in partnership with the National Association of Secondary School Principals (NASSP), are presented annually on the local, state and national level. honored with Prudential Spirit of Community Awards over the past 11 years! How does the program work? In September, application forms and instructions are sent to all U.S. middle level and high schools, and to these officially designated local organizations: Girl Scout councils, county 4-H organizations, American Red Cross chapters, YMCAs, and member Volunteer Centers of the Points of Light Foundation & Volunteer Center National Network. Each participating school/organization collects applications from interested students/members by October 31, 2006, then selects one middle level Local Honoree for every 1,000 students or members in grades 5-8, and/or one high school Local Honoree for every 1,000 students or members in grades 9-12. From these winners, the top high school and middle level youth volunteer in each state and the District of Columbia are named State Honorees in early February. Finally, ten of these State Honorees are named America's top ten youth volunteers of the year by a distinguished national selection committee at a special ceremony in Washington, D.C. in May. What do honorees receive? • Local Honorees receive Certificates of Achievement from their schools or organizations. Those who qualify also receive the President’s Volunteer Service Award, recognizing their efforts to answer the President’s Call to Service. • State Honorees receive $1,000, engraved silver medallions, and an all-expense-paid trip with a parent or guardian to Washington, D.C. in May for several days of recognition events, including award ceremonies, sight-seeing tours, and Congressional visits on Capitol Hill. • Distinguished Finalists (runners-up at the state level) receive engraved bronze medallions. • Other top applicants at the state level receive Certificates of Excellence. • National Honorees receive additional $5,000 awards, engraved gold medallions, and crystal trophies for their schools or organizations. They also will receive $5,000 grants from the Prudential Foundation for nonprofit charitable organizations of their choice. Who is eligible? Any student who: • is in grades 5-12 as of October 31, 2006, and is a legal resident of one of the 50 states of the United States or the District of Columbia • has engaged in a volunteer activity that occurred at least in part after September 1, 2005 • completes an application and submits it to a school principal or the head of an officially designated local organization by October 31, 2006 Important Dates September 2006 Applications and program instructions are mailed to all middle level and high schools and to officially designated local organizations (see below), and are available at www.prudential.com/spirit, or by calling toll-free 1-888-450-9961. October 31, 2006 Students must complete applications and return them to a school principal or the head of an officially designated local organization by this date. November 1-7, 2006 Participating schools and organizations review applications, then select and submit Local Honorees for state-level judging. February 13, 2007 Judges name the top middle level and high school youth volunteer in every state and the District of Columbia as State Honorees. May 5-8, 2007 102 State Honorees attend national recognition events in Washington, D.C., at which time America’s top ten youth volunteers of the year are announced. Applicants must submit completed applications to one of the following: ❊ ❊ ❊ ❊ ❊ ❊ A middle level or high school A Girl Scout council A county 4-H organization An American Red Cross chapter A YMCA A member Volunteer Center of the Points of Light Foundation & Volunteer Center National Network THE PRUDENTIAL SPIRIT OF COMMUNITY AWARDS PROGRAM IS WIDELY SUPPORTED! For more information: www.prudential.com/spirit www.principals.org/prudential 1-888-450-9961 spirit@principals.org On the cover: Actor and environmentalist Ted Danson congratulates North Dakota’s 2006 State Honorees, Miranda Uriell and Benjamen Sun. The Prudential Spirit of Community Awards program is sponsored by Prudential Financial in partnership with the National Association of Secondary School Principals. The program is supported by the National 4-H Council, Girl Scouts of the USA, American Red Cross, the Points of Light Foundation & Volunteer Center National Network, YMCA of the USA, the American Association of School Administrators, the Council of the Great City Schools, the National Middle School Association, the National School Boards Association, the National School Public Relations Association, and numerous other national organizations.