AWC Center for Quality Communities
2021 scholarship application
The AWC Center for Quality Communities (CQC) is oering up to six $1,500 scholarships to graduating high school students. At the
discretion of the scholarship selection committee, up to two scholarships may be awarded to past CQC scholarship recipients who
are continuing their education. Please type or print. Illegible or incomplete applications will be returned.
Continue application on back.
1. First name: Last name:
Mailing address
Street/P.O. Box:
City: State: Zip:
3. Best phone number to reach you: Email:
Current high school: Number of years attended
If home-schooled, please check box:
If GED, please indicate date received:
Have you been accepted into an accredited post-secondary program or
college for the fall of 2021 as of this submission? Yes No
If yes, please provide institution name(s):
If not, please indicate the name of the institution(s) you plan to attend:
Proof of student enrollment from the school is required prior to the release of funds.
Career goals (please be specic):
Contact information of parent(s) or legal guardian(s)
City: State: Zip:
Primary phone:
Email address:
Please describe your nancial need. Include any nancial aid you will receive and/or any circumstances that would
help the committee understand your nancial situation.
List your city, community and civic involvement activities. (No additional materials will be accepted.)
List your school involvement and academic honors and awards. (No additional materials will be accepted.)
Personal essay
In a separate document, write a concise essay in response to the following question. Please limit the length to two
A sign of a good leader is being able to guide yourself and others through both good and challenging times, demonstrating
high standards of responsibility, and showing commitment to community. Tell a story about a signicant community
responsibility you assumed or were given. How did this experience help you grow as a leader? How did the project impact
others? What did you gain?
Applicant checklist (Send completed application packet to city for consideration):
Completed application including essay
Must be in good academic standing
Must be eligible to graduate spring/summer 2021
Completed and signed release form
Letter of recommendation from a nonrelative (such as a
community leader, high school teacher, principal, or counselor).
This is separate from the letter of support from the city.
Statement of accuracy
I hereby arm that all of the information provided above is true and correct to the best of my knowledge.
I agree that the scholarship funds will be sent directly to the educational institution.
I agree that if I don’t use the funds awarded to me by May 31, 2022, they will be returned to the scholarship fund.
I understand that if chosen as a scholarship winner, I must provide evidence of enrollment/registration at an
accredited post-secondary institution of my choice before scholarship funds can be awarded.
Signature of scholarship applicant: Date:
Submit scholarship application to city for consideration.
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AWC Center for Quality Communities
Release and consent for use
of name and image/photo
The purpose of this form is to request permission to use your photo/image and name in our scholarship program
materials, website, and/or social media as part of the AWC Center for Quality Communities.
I grant permission for my (or my child’s) photo/image and name to be used in connection with the AWC Center
for Quality Communities scholarship program materials, website, and/or social media, including any and all uses
of video and any portraits, still pictures, or other photographic reproductions and sound recordings in which I (or
my child) may be portrayed.
Nothing herein shall constitute any obligation on the part of the AWC Center for Quality Communities to make
any use of any of the materials or rights granted.
I hereby grant permission and execute this release as of the date and year below.
Signature Signature of parent or guardian
(required for minors under 18 years of age)
Printed name Relationship to minor
If you or your parent or guardian wish to rescind this agreement and remove your information or photo, you may
do so at any time in writing by sending a letter to the AWC Center for Quality Communities. Such rescission will
take eect upon receipt by the AWC Communications department.
If you have questions, contact Karen Tanner at or 1-800-562-8981.
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