TOWNSHIP OF BERWYN Board of Trustees Amelia Sordelli Beverly Pastorek Donna Calvello Edward Espinoza

Supervisor Elizabeth A. Pechous Town Clerk Thomas J. Pavlik Assessor David J. Avila

"A Tradition of Service" Dear Berwyn Student:

Berwyn Township is pleased to announce $4,000.00 total funding for scholarships is being awarded to eligible 4th thru 8th grade students throughout the City of Berwyn to be utilized for education enrichment programs. Eligibility for the scholarship is as follows: 1. Must be a 4th – 8th with a minimum “B” average or equivalent GPA. 2. Must be a resident of Berwyn, Illinois. 3. Must have a history of extracurricular activities that demonstrate a willingness to accept leadership responsibilities and a willingness to serve the community (community service projects, volunteer activities with local service agencies or charitable institutions, etc.) 4. Must submit two letters of recommendation. The initial letter must be submitted by a teacher with the secondary letter coming from a counselor, local official, or business person. 5. Must submit a completed application form. 6. Scholarship funds must be applied toward an after school/summer academic program. 7. Monetary award will be paid direct to school/summer academic program. (Does NOT include sports, athletic, or recreational programs). Please complete this application so we can determine your eligibility for receiving funds set aside to enrich your education. Complete this application no later than April 3, 2017 and forward the entire application to the Berwyn Township offices at 6600 W. 26th Street, Berwyn, IL 60402. If any questions are not applicable to your current situation, please attach an explanatory note referring to the questions by section. If more space is required for information on any items, you may attach additional information. Please indicate appropriate sections. You are responsible for seeing that all supporting documents are submitted. Berwyn Township reserves the right to process only applications found to be complete as of the application postmark deadline. Certification and Permission to use “Recipient Information” to Announce Scholarship Winners In submitting this application, I certify that the information provided is complete and accurate to the best of my knowledge. Falsification of information may result in termination of any scholarship granted. I agree that if I am offered an award from The Berwyn Township, The Berwyn Township may use my name, photograph or likeness, the name of my community, the name and address of my school, the amount of the award, and the name of the program I will be attending in press releases, public announcements, and other fundraising or promotional materials in all media (including the Internet), to advance the non-profit objectives of The Berwyn Township Scholarship Program.

Applicant’s Signature

Date

Parent or Legal Guardian Signature

6600 W. 26th Street • Berwyn, IL 60402 • (708) 788-6600 • (708) 788-2301 • Fax (708) 788-0432

TOWNSHIP OF BERWYN PERSONAL DATA

(*must accompany application)

List all school activities in which you have participated during the past 4 years (e.g. student government, music, sports, etc.) List all community activities in which you have participated without pay during the past 4 years (e.g. Red Cross, church work, volunteer work, Scouting). Indicate all special awards, honors. Activity

No. of years participated

Special Awards and Honors

Make a statement of your plans as they relate to your educational objectives and future goals.

*Please describe in 500 words or less on how the program will enrich your education. Please attach a separate sheet.

PLEASE PRINT OR TYPE 6600 W. 26th Street • Berwyn, IL 60402 • (708) 788-6600 • (708) 788-2301 • Fax (708) 788-0432

TOWNSHIP OF BERWYN APPLICANT DATA

Name (Last)

(First)

Permanent Address (Street)

(Middle Initial)

(City)

(State)

(Zip)

Date of Birth (month/day/year) Name of Parent/guardian: Permanent mailing address of parent/ Guardian if different from applicant:

(Street)

(City)

(State)

(Zip)

Telephone Number: Email address: ____________________________________________________________

Program choice and Location: 1) _______________________________________________ 2) _______________________________________________ 3) _______________________________________________

*Please attach program brochure/description and cost.

6600 W. 26th Street • Berwyn, IL 60402 • (708) 788-6600 • (708) 788-2301 • Fax (708) 788-0432

TOWNSHIP OF BERWYN SCHOOL DATA Grammar School/Middle School attending: Name of School Principal: School Address: School Phone Number:

OTHER AWARDS Please list below the name and amount of any grants or scholarships that you have been awarded for the coming school year.

Name of Award

Amount

Granted

Pending

6600 W. 26th Street • Berwyn, IL 60402 • (708) 788-6600 • (708) 788-2301 • Fax (708) 788-0432

TOWNSHIP OF BERWYN

SCHOLARSHIP APPLICATION CHECKLIST 1. ________ 4th-8th grade student with a minimum “B” average or equivalent GPA 2. ________ Resident of Berwyn, IL 3. ________ History of extracurricular activities 4. ________ Essay. 500 words or less on how the program will enrich your education 5. ________ Two letters of recommendation 6. ________ Completed application form with student’s signature and dated 7. ________ Program choices and brochure/description with costs

All items must be submitted together for an application to be considered complete. No exceptions will be made and all decisions are final. Faxed applications will not be accepted. All applicants should expect to receive notification of a decision of their application after April 10th, 2017. Notification of an award will be given by telephone or direct mail. Only one application per applicant will be considered. Any questions may be directed to Berwyn Township at 708-788-6600. Please mail your completed application, postmarked no later than April 3, 2017 to: Berwyn Township Attn: Education Enrichment Scholarship Program 6600 W. 26th Street Berwyn, IL 60402

6600 W. 26th Street • Berwyn, IL 60402 • (708) 788-6600 • (708) 788-2301 • Fax (708) 788-0432

Scholarship .pdf

responsibilities and a willingness to serve the community (community service projects, volunteer activities with. local service agencies or charitable institutions, ...

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