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    

SPRING 2013

 

 

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)

                                dkisselback@silverbay.org

                                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)

 

 

___________________________________________

  (Date)

 

Children and Grandchildren of Rotarians are NOT eligible to apply for this scholarship.

 

Meeting Time & Location Information Thursday at 12:15 PM Queensbury Hotel 88 Ridge Street Queensbury, NY 12801  map it USA	Contact Information Dr. Shelle Kelz phone: 518-743-0773 fax: 518 743-0774 contact us www.glensfallsrotary.com