St. Madeleine Sophie Mens Association

Service Award for Post High School Study

Code No. _______

APPLICATION - Page 2

For all of the following, please use the numerals 1, 2, 3, 4 for freshman, sophomore, junior and senior years respectively, to indicate years of participation. Additionally, please indicate the name of an adult (non-family member) who can verify your participation. Use the reverse side of this sheet if additional space is needed.

Parish/Church Service - List activities in which you have been involved, noting any leadership roles you have assumed, and any awards you received.

          Service Activity                                                                                              Verification

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Community Service - List activities in which you have been involved, noting any leadership roles you have assumed, and any awards you received.

          Service Activity                                                                                              Verification

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Extracurricular Activities - List activities in which you have been involved, noting any leadership roles you have assumed, and any awards you received.

          Service Activity                                                                                              Verification

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Applicant Statement - On a separate sheet of 8 1/2 X 11 inch paper, provide a statement of no more than 300 words in length. Describe how your involvement in Church/Community/School activities while in high school will serve as positive preparation for your future life. What personal goals have you set for yourself, and how will these activities, along with your future involvements, aid you in meeting these goals. You may wish to include comment regarding meaningful employment or personal experiences which have had a significant impact on you.

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