<p> EMMETT J. DOERR MEMORIAL SCOUT SCHOLARSHIP APPLICATION</p><p>Name: Date: </p><p>Date of Birth: Phone: </p><p>Home Address: </p><p>E-mail Address: </p><p>Unit: Troop # Team # Crew # </p><p>Unit Chartered To: </p><p>Date of Eagle Scout and/or Silver Award </p><p>Date of Ad Altare Dei and/or Pope Pius XII </p><p>Name of academic institution at which you have been accepted or to which you have applied: </p><p>Name of high school attending: </p><p>Name of church/parish: </p><p>(NOTE: Additional sheets may be used if needed to answer each of the following sections to the fullest.)</p><p>1) Document reasons why you should be selected as a recipient of the Emmett J. Doerr Scholarship (essay not required).</p><p>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</p><p>National Catholic Committee on Scouting® • Boy Scouts of America • 1325 West Walnut Hill Lane, P. O. Box 152079, Irving, TX 75015 2079 Page 2 2008 Printing www.nccs-bsa.org Emmett J. Doerr Memorial Scout Scholarship Application</p><p>2) List dates and positions held in Scouting:</p><p>List awards received:</p><p>3) Service to the Church—What have you done or are currently doing, positions held (if any), and for how long?</p><p>List awards received:</p><p>National Catholic Committee on Scouting® • Boy Scouts of America • 1325 West Walnut Hill Lane, P. O. Box 152079, Irving, TX 75015 2079 Page 3 2008 Printing www.nccs-bsa.org Emmett J. Doerr Memorial Scout Scholarship Application</p><p>4) GPA_____/Scale_____ Name of Honor Society(s) </p><p>Service to the School—What have you done or are currently doing, positions held (if any), and for how long?</p><p>List awards received:</p><p>5) Service to the Community—What have you done or are currently doing, positions held (if any), and for how long?</p><p>List awards received:</p><p>National Catholic Committee on Scouting® • Boy Scouts of America • 1325 West Walnut Hill Lane, P. O. Box 152079, Irving, TX 75015 2079 Page 4 2008 Printing www.nccs-bsa.org Emmett J. Doerr Memorial Scout Scholarship Application</p><p>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.</p><p>Press Release Waiver</p><p>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.</p><p>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. </p><p>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®. </p><p>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.</p><p>Signature of Applicant</p><p>Signature of Parent or Legal Guardian (if applicant is under 18 years old)</p><p>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: </p><p>NCCS—Emmett J. Doerr Memorial Scout Scholarship ATTN: Mrs, Jan Winters P.O. Box 152079 Irving, TX 75015-2079</p><p>National Catholic Committee on Scouting® • Boy Scouts of America • 1325 West Walnut Hill Lane, P. O. Box 152079, Irving, TX 75015 2079 Page 5 2008 Printing www.nccs-bsa.org Emmett J. Doerr Memorial Scout Scholarship Application</p><p>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</p>