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Union League Of Philadelphia Good Citizenship Award - Girl Scouts Of Eastern Pennsylvania Page 3

Reference Form for Union League of Philadelphia Good Citizenship Award

Nominee’s Name ________________________________________________________________

Reference’s name________________________________________________________________

Address

City ____________________________________________ State _________ Zip Code__________

Reference’s email ___________________________________________ Phone ________________

Reference’s signature ______________________________________________________________

Please answer the following questions and attach them to the reference form.

In what capacity do you know the nominee?

2. How long have you known this nominee?

3. Describe personal characteristics the nominee has demonstrated to be singled out for this award.

4. List specific accomplishments or recognitions earned by the nominee.

5. Describe specific leadership roles she performed which distinguish her as an outstanding citizen.

6. Describe how the nominee has shown marked evidence of good citizenship as manifested by

cooperative effort, self-control, perseverance, good sportsmanship, and endeavor to follow and

uphold the best traditions and principles of the “American Way of Life.”

Application Deadline

Application and reference forms must be received by January 15, 2013 at 5:00 p.m . Applications and

references can be mailed, emailed, or dropped off at any of the Girl Scout Service Centers. Faxes will

not be accepted.

Selection

The Scholarship Committee will review all applications. Girls’ names, addresses, troop number, and other

identifying information are concealed to ensure anonymity and fairness. Award recipients will be

personally notified and recognized at the Spring 2013 Girl Scouts of Eastern Pennsylvania Achievement

Ceremony.

Mailing address: Electronic form s are preferable. Email applications and references to:

or mail to: GSEP, Joan Hannahoe, 2633 Moravian Avenue, Allentown, PA 18103.

Union League Of Philadelphia Good Citizenship Award - Girl Scouts Of Eastern Pennsylvania Page 3