Josh Palmer Scholarship

The Josh Palmer Scholarship is awarded to an individual who has demonstrated a commitment to excellence despite personal adversity. The recipient of this award must have demonstrated pride, loyalty, and a commitment in their everyday endeavor, while striving to give back to their communities. Awards will be as follows:

· We will be distributing $5,000 this year based on applications received

The candidate must meet the following criteria:

· Experience overcoming an obstacle related to physical adversity

· Residency in Chemung, Steuben, Schuyler or Tioga (PA) Counties

· Experience in leadership roles

· Dedication to community involvement

· Good academic standing, but not necessarily the highest GPA, rather a student that strives to achieve his/her best at all times.

Eligibility requirements

Return the following to the Fund’s office by May 13, 2022

· A completed application form (It is important that you answer all the applicable questions.)

· A typed essay

· A reference letter

· A transcript that includes GPA and SAT scores

*Please return all requested information to ensure a complete process of the application. If you have any questions, please contact the Fund office at (607) 733-2354 or joshpalmerfund@gmail.com

2022 Josh Palmer Scholarship Application

Completed applications must be returned to the Fund office post office box by May 13, 2022.

Last name First name MI

Address

High School School District

Guidance Counselor’s name Guidance Counselor’s phone number

List parents or guardians names and addresses if not same as student.

Name Name

Address Address

Home phone Work phone

Email address

List all siblings and those who are financially dependent. Give age, college or occupation:

Field of study you plan to pursue:

Name of institution you expect to attend:

Accepted Pending Enrolled

Housing plans: On campus Off campus

What are your career goals upon completion of your higher education?

Give details regarding other scholarships, grants or loans you are seeking or have already received. Include amount.

Please attach a separate sheet listing the following information by year (if applicable):

· Participation in varsity, junior varsity and/or community teams

· Memberships and participation in school organizations and activities

· Leadership roles/elected offices

· Awards received

· Volunteer experience

· Membership and participation in community organizations

· Employment experience

Include the approximate number of hours per week or month spent participating in each activity.

Please indicate any unusual family or personal circumstances you feel warrant attention:

ESSAY

Write a brief essay about how overcoming a personal adversity may have motivated you to contribute to the betterment of your school or the community in general. Choose something that you are proud of achieving or participating in that would show the Committee what motivates you and what special skills or attributes you have.

Please submit in typewritten, double space format.

TRANSCRIPT

Please attach a copy of your transcript that includes class rank, GPA and SAT scores.

REFERENCE

Please provide the Fund with reference from someone who worked with you or who is familiar with your contribution. A brief paragraph is all that is needed. Your reference can be attached to your application or sent independently. If it sent independently, please include the applicant’s full name so that it can be attached to the appropriate application.

I hereby authorize the Josh Palmer Fund Inc. to share this information with members of the Scholarship Committee.

Applicant’s Signature Parent/Guardian Signature

Date:

CERTIFICATION

I hereby affirm that the information on this form is true and complete to the best of my knowledge. I am aware of the conditions under which the awards are made and promise to inform the Josh Palmer Fund Inc. of any changes in circumstances of any additional aid received.

Applicant’s Signature Parent/Guardian Signature

Date:

If you have any questions, please contact the fund: joshpalmerfund@gmail.com or (607) 733-2354.

Please return to: The Josh Palmer Fund, Inc.

PO BOX 3223

Elmira, NY 14905