Emmett J. Doerr Memorial Scout Scholarship Application

EMMETT J. DOERR MEMORIAL SCOUT SCHOLARSHIP APPLICATION

Name: Date:

Date of Birth: Phone:

Home Address:

E-mail Address:

Unit: Troop # Team # Crew #

Unit Chartered To:

Date of Eagle Scout and/or Silver Award

Date of Ad Altare Dei and/or Pope Pius XII

Name of academic institution at which you have been accepted or to which you have applied:

Name of high school attending:

Name of church/parish:

(NOTE: Additional sheets may be used if needed to answer each of the following sections to the fullest.)

1) Document reasons why you should be selected as a recipient of the Emmett J. Doerr Scholarship (essay not required).

National Catholic Committee on Scouting® • Boy Scouts of America • 1325 West Walnut Hill Lane, P. O. Box 152079, Irving, TX 75015 2079 Page 1 2007 Printing www.nccs-bsa.org Emmett J. Doerr Memorial Scout Scholarship Application

2) List dates and positions held in Scouting:

List awards received:

3) Service to the Church—What have you done or are currently doing, positions held (if any), and for how long?

4) GPA_____/Scale_____ Name of Honor Society(s)

Service to the School—What have you done or are currently doing, positions held (if any), and for how long?

5) Service to the Community—What have you done or are currently doing, positions held (if any), and for how long?

6) List any other organizations, activities, positions held, length of service, awards received or any other information that you would like the Scholarship Committee to consider.

Press Release Waiver

In the event of your selection as a scholarship recipient, we will be issuing a press release to the national media. To do this, we need your permission. Your decision, in no way, affects our selection process.

I, , give permission to the National Catholic Committee on Scouting® to release my name and photograph for the purpose of recognizing my award of an Emmett J. Doerr Memorial Scout Scholarship.

By this authorization, I understand and agree that no recipient shall receive remuneration and that all rights, title and interest to the photos and/or text and their use belongs to the National Catholic Committee on Scouting®.

I also understand that members of the press may request interviews with recipients, and that the recipients have the right to decline such interviews. This agreement is in effect until October 1 of the scholarship award year.

Signature of Applicant

Signature of Parent or Legal Guardian (if applicant is under 18 years old)

Submit your completed application along with recommendation letters, a high school transcript, and a 3”x5” photo to arrive no later than March 1st to:

NCCS—Emmett J. Doerr Memorial Scout Scholarship ATTN: Mrs, Jan Winters P.O. Box 152079 Irving, TX 75015-2079

National Catholic Committee on Scouting® • Boy Scouts of America • 1325 West Walnut Hill Lane, P. O. Box 152079, Irving, TX 75015 2079 Page 6 2008 Printing www.nccs-bsa.org