MLK Scholarship Nomination Form

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MLK Scholarship Nomination Form

Thank you for nominating a student for the Martin Luther King Scholarship! Students not selected for the scholarship will receive the Outstanding Young Person Award. Incomplete nominations will not be considered for an award. If you encounter any problems, please contact Amy Good at agood@ulgm.org or 608.729.1208.

School

Child's First Name

Child's Last Name

Phonetic Spelling of Child's Name

Parent/Guardian's First Name

Parent/Guardian's Last Name

Parent/Guardian's Street Address

Parent/Guardian's City

Parent/Guardian's Zip

Parent/Guardian's Primary Phone Number

Parent/Guardian's Secondary Phone Number

Parent/Guardian's E-mail address

Current Grade Level

12th grade

I certify that the child's GPA is at or above 2.5

	Yes
	No--CHILD IS INELIGIBLE

Person nominating student

Nominator's Phone Number

Nominator's Fax Number

Nominator's Email

Nominator's Job Title

Personal Qualities and Characteristics
(Discuss grades, honor roll, student awards, attitude in classroom, success despite extenuating personal circumstances, etc.)

School Activities and Experiences
List any honors, awards, and/or special recognitions received during high school

Describe the student's participation in extra-curricular (school-based) activities, clubs, sports, groups, special skills, etc.

List any Advanced Placement Courses, honor courses, internships, and/or similar learning experiences

Contributions to Community
Describe the student's volunteer contributions to benefit their community (include both one-time volunteer activities, like a food drive, and on-going volunteer activities, like visiting nursing homes.) Helping relatives, doing chores at home, paid employment, playing sports, etc. DOES NOT qualify

Other Activities
List jobs, responsibilities, and any other challenges the student has had while in high school

Other
Include any other pertinent information about the student here

Upload documents here
You may upload transcripts, letters of recommendation, or any other items here you would like the committee to consider.

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