$1,500 Honor Service Award Available to a Student or Alumni of a County within the Keystone SMILES network – see regional map below. $1,250 Silver Service Award Available to a Student or Alumni of a Clarion County Public or Private School Name of Clarion County School: ____________________________________

$750 Bronze Service Award Available only to Student or Alum of: Clarion Career Center Keystone High School Keystone SMILES Alternative Education Program

Applications must be submitted online and certifications post marked no later than May 31st

Send Certification Page to: Ross McGinnis Memorial Service Award Keystone SMILES P O Box 352 Knox, PA 16232

PFC Ross McGinnis Memorial Service Award Instructions

These Memorial Awards recognize young leaders who

have demonstrated outstanding humanitarian

efforts and citizenry activities while serving their community, school, church,

and country.

Keystone SMILES Inc. www.smilesamericorps.org

Memorial Service Awards to be

announced on June 14th

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Service Making an Impact through Learning Experiences with Students

Copyright 2006 Keystone SMILES, Inc., 10/4/2011

www.smilesamericorps.org

Application Instructions

1. Review Eligibility requirements 2. Completed ONLINE Application found at https://www.keystonesmiles.org/Memorial_Award.htm

Or directly at https://keystonesmiles.wufoo.com/forms/z19pn74c0riipqr/ a. Complete all items on checklist detailed on certification page in this document b. Upload all required items

3. Print and complete certification page (page 3 of this document) and send to Keystone SMILES at PO Box 352; Knox, PA 16232

ELIGIBILITY/ APPLICANT REQUIREMENTS

Must demonstrate participation in an outstanding service project or activity addressing human needs, environment, public safety or education which benefited an individual or group. (AmeriCorps service hours do not count toward this award)

The Honor “Service” Award - must have attended or currently attends a high school or post-secondary school located in a county identified on the regional map. (Refer to map illustration.)

The Silver “Service” Award - must have attended or currently attend a Clarion County Public or Private School and be enrolled in a post-secondary technical / career / educational institution to access the award.

The Bronze “Service” Award – must have attended or currently attends Keystone High School, Clarion Career Center or Keystone SMILES Alternative Education Program and be enrolled in a post-secondary technical / career / educational institution to access the award.

Has not been a recipient of this Award previously. This is a one-time award.

Must have a minimum of 2.75 GPA at time of application and Award disbursement.

Must be a U.S. citizen or permanent resident.

Applicant agrees to be present at the annual Award Ceremony to be held at the Keystone SMILES Community Learning Center in Knox, PA.

AWARD INFORMATION

The Honor “Service” Award will be in the amount of $1,500. Eligible applicants must be a current student or alumnus of a school within a county identified on the regional eligibility map.

Award will be released only to the post-secondary school the recipient is attending. Funds will be released after recipient completes one school year of post-secondary education with a GPA of 2.75 or higher.

The Silver “Service” Award will be in the amount of $1,250. Eligible applicants must be a current student or alumnus of a Clarion County school.

Award will be released only to the post-secondary school the recipient is attending. Funds will be released after recipient completes one school year of post-secondary education with a GPA of 2.75 or higher.

The Bronze “Service” Award will be in the amount of $750. Eligible applicants must be enrolled or be an alumnus of Keystone High School, Clarion County Career Center, or Keystone SMILES Alternative Education Program.

Award will be released only to the post-secondary school the recipient is attending. Funds will be released after recipient completes one school year of post-secondary education with a GPA of 2.75 or higher.

3

Service Making an Impact through Learning Experiences with Students

Copyright 2006 Keystone SMILES, Inc., 10/4/2011

www.smilesamericorps.org

CERTIFICATION PAGE To be signed and mailed in as to complete the application process

Applicant Name _ _________________________________________________ Have you ever served as an AmeriCorps member? _____ YES _____ NO

Initial all appropriate award(s) that you are applying for:

_____$1,500 Honor Service Award Available to a Student or Alumni of a County within the Keystone SMILES network –see regional map below. _____$1,250 Silver Service Award Available to a Student or Alumni of a Clarion County Public or Private School

Name of Clarion County School: ____________________________________

_____ $750 Bronze Service Award – Only available to students or alumni of: (check one)

____Clarion Career Center ____Keystone High School ____Keystone SMILES Alternative Education Program

CERTIFICATION

I (applicant name) verify the enclosed information submitted with this application is true and is accurately documented. Applicant Signature ____________________________________________________ Date: _____ /_____ /______ If 17 years of age or younger, parent signature is required:

Parent or Guardian Signature_____________________________________ Date:_____/____/_____

Parent Information Contact Phone Number: ______________________ email address: ____________________________________

Please

Required online and printed Paperwork

Completed ONLINE Application found at https://www.keystonesmiles.org Or directly at https://keystonesmiles.wufoo.com/forms/z19pn74c0riipqr/ Includes a 500-1000 word Essay of Outstanding Service (online application-Page 4)

Completed Resume (uploaded as attachment to online application) – example in these instructions

Service Reference Letter (uploaded as attachment to online application

Character Reference Letter (uploaded as attachment to online application

Documentation of High School Attendance and GPA (High School Diploma and either High school / College Transcripts) (uploaded as attachment to online application

Picture for Media Release (uploaded as attachment to online application

This Certification page signed and mailed to Keystone SMILES at PO Box 352; Knox, PA 16232

4

Service Making an Impact through Learning Experiences with Students

Copyright 2006 Keystone SMILES, Inc., 10/4/2011

www.smilesamericorps.org

Julieta Jones 1234 Roman Drive, Knox PA 16232

814-797-1111 - jjones@youremail.com Education Year(S)

Gannon University , Erie PA 2004-present Business Administration Minor - Marketing Clear Creek High School, Clarion County 1999-2004 General Studies - QPA 2.90 Immaculate Conception Elementary School 1991-1999 Kindergarten-eight grade

Memberships in clubs, organizations and sports Year (s)

President Student Council 2001-2002

4-H Club member 1995 – 2004

Clear Creek High School – Basketball Team 1999-2003

Rising Stars AAU Coach - 7th grade 1997-1998

Awards/recognition Year (s)

Keystone SMILES Charity Challenge President Youth Scholarship Award 2004 Volunteered 300 hours of community Service 2004

4 -H Outstanding Youth Volunteer Award 2003

Service EXPERIENCE – Includes Volunteer, National, or Military Year (s)

Youth Field Day Volunteer 2005-Present Sunday School Bible School Aide 2001-2004

Service Volunteer Serve in a summer youth corps program mentoring youth ages 10-14

1995 - 1999

Work Experience Year (s)

Wal-Mart Cashier 2003-present Customer service, cashier-summer Clarion PA Katie’s Ice Cream Shop 1999-2000 Strattanville, PA

Use this resume format when creating your resume as part

of your application.