Rotary Scholarship 2013 Guidance Counselor Certification Form
GLENS FALLS ROTARY CLUB
P.O. Box 4702
Queensbury, NY 12804
COMMUNITY SERVICE SCHOLARSHIP GUIDANCE COUNSELOR CERTIFICATION FORM
STUDENT APPLICANT’S NAME: ____________________________________________________
APPLICANT’S HIGH SCHOOL: ______________________________________________________
GUIDANCE COUNSELOR: _________________________________________________________
Guidance Counselor’s phone number: ______________________________________________
Guidance Counselor’s e-mail address: ______________________________________________
The section below is to be completed only by the student’s Guidance Counselor. Once signed by the Guidance Counselor, the Certification Form should be forwarded via e-mail to:
David Kisselback (Chairman, Glens Falls Rotary Scholarship Committee)
Please call David at 518-543-8833 x 201 if you have any questions.
TO: Rotary Scholarship Committee
I hereby certify that the applicant named above has attained at least a “B” average and therefore meets this academic requirement to be considered for the 2013 Glens Falls Rotary Club Community Service Scholarship.
(Print Guidance Counselor Name)
(Guidance Counselor Signature)
Children and Grandchildren of Rotarians are NOT eligible to apply for this scholarship.