APPLICATION FOR
JACKIE BURK MEMORIAL AWARD AND

ALLAN HOMES AWARD

FOR OUTSTANDING STUDENT VOLUNTEER FOR

SPECIAL OLYMPICS HOWARD COUNTY

 

(Please type or print.)

 

 

NAME_________________________________________________________

 

ADDRESS _____________________________________________________

 

CITY ______________________________ STATE  _______ ZIP_________

 

PHONE NRS (HOME)___________________ (CELL)__________________

 

FATHER’S NAME_______________________________________________

 

ADDRESS (if different than student) ____________________________________

 

CITY_______________________________STATE_________ZIP _________

 

MOTHER’S NAME_______________________________________________

 

ADDRESS (if different than student) ____________________________________

 

CITY_______________________________STATE_________ZIP _________

 

HIGH SCHOOL __________________________________________________

 

HIGH SCHOOL ADDRESS:________________________________________

 

HIGH SCHOOL PRINCIPAL: ______________________________________

 

DATE OF GRADUATION ______________________GPA _______________

 

POST-HIGH SCHOOL EDUCATION PLANS: (include technical schools/colleges, etc.  applied to/accepted to; major):

 

 

 

 

 

 

 

 

IF CURRENTLY IN COLLEGE:

 

COLLEGE ____________________________________________________________

 

COLLEGE ADDRESS__________________________________________________

 

ANTICIPATED GRADUATION YEAR ___________________________________

 

MAJOR __________________________________MINOR _____________________

 

SUMMARIZE INVOLVEMENT WITH SOHO (include sports/events that you have volunteered with, number of hours and years of involvement. Be specific.)

 

 

 

 

 

 

 

 

 

 

 

ESSAY: DESCRIBE (500 words or less) WHAT YOUR INVOLVEMENT IN SOHO HAS MEANT TO YOU AND WHAT IMPACT IT HAS HAD ON YOUR LIFE.

 

 

 

 

 

 

 

 

 

 

 

ATTACH AT LEAST ONE RECOMMENDATION LETTER FROM A SOHO COACH, MANAGEMENT TEAM MEMBER, AND/OR SPORTS COORDINATOR.