one by one we make a difference

APPLICATION FORMS: TEAM SCHOOL AWARD APPLICANTS:

PRINT BLANK FORM

 

Statement of Purpose:

The Louise Russo Youth Awards recognize youth who exemplify “the 3R’sRespect, Responsibility and the Role of leadership They do this through initiatives that reduce violence and create positive changes in their school community.

Applicant Requirements:

  • Must be grade 7-12
  • Presently enrolled in an Elementary or Secondary School Program.
  • This application must only be filled out by the candidate applying for the award and not an adult.
  • Teams must select one individual to fill out this application.

Team/School Information

Name of school/organization/group:*
Address:*
Phone Number: *
-
List Contact Person: *
Contact No.:*
-
E-mail*
Contact Person Address:*
Alternate Name: *
Phone Number *
How many students in your team: (provide numbers)*

Support/Reference Letters:
Please ensure you enclose your two support/reference letters with your submission.

Below, please list the two individuals who provided you with support/reference letters.

Please note: Support/reference letters should give examples of how the applicant reflects the Award’s
statement of purpose and values.

Support/Reference Letters #1

#1 Name*
#1 Relationship:*
#1 Organization:*
#1 Contact No.:*
-
E-mail Address: *
#1 Support Letter - Upload here*


Support/Reference Letters #2

#2 Name *
#2 Relationship:*
#2 Organization:*
#2 Contact No.:*
-
E-mail Address:*
#2 Support Letter - Upload here*

Application Questions:
1) Please list what your team has done in the last 1 to 5 years to merit the Louise Russo Youth Award?*
2) How do you see your contribution and/or accomplishments continued in the future?*

3) Exemplify “the 3R’s” – Respect, Responsibility and the Role of leadership and how your program and/or actions have affected your school and/or community:


a. Respect:
a. 1)*
a. 2)*
a. 3)*

b. Responsibility:
b. 1)*
b. 2)*
b. 3)*

c. Role of Leadership:
c. 1)*
c. 2)*
c. 3)*
4) How have your team’s actions made a difference in your school and/or your community?*


5) Please submit on a 250 word essay on “what inspires us to believe that one by one we can make a difference.” and upload it here.


Upload here:*

Authorization:

I/we certify that the information provided on this application form is true and accurate. All information on this application will be kept confidential and on file by Louise Russo W.A.V.E. (Working Against Violence Everyday).

If our application is selected for an award, I/we authorize our team name, photo and award details to be publicized. Finally, I/we understand that I/we are required to attend the W.A.V.E. Empowering Youth Day on Wednesday May 10, 2017 at the Living Arts Centre in Mississauga, Ontario. I/we agree that I/we will make the necessary adjustments to our schedule to ensure that I/we will be able to attend this one-day ceremony.

Date:*


Parental/Guardian Endorsement:

Parent/Guardian/School Official endorsement required if student is under 18 years of age

I endorse this application and verify the information:

Parental/Guardian Name:*
Relationship:*
Contact No.: *
Endorsement Date:*

Deadline for Submission:

Completed applications and supporting material must be received by:
Friday March 10, 2017

Submissions:

    Options:

  • Submit online
  • Email to info@louiserussowave.ca
  • Mail to address below (Please note courier is not accepted at the P.O. Box)

Louise Russo W.A.V.E. (Working Against Violence Everyday)
P.O. Box 60791
RPO Jane Wilson North York, Ontario M3L 2N5

www.louiserussowave.ca
Registered Charitable #84950 2950 RR0001

 

Warning: Unknown: open(/var/php_sessions/sess_acc2a061c9e82dd6b2c14d1d5e9e2a42, O_RDWR) failed: No such file or directory (2) in Unknown on line 0 Warning: Unknown: Failed to write session data (files). Please verify that the current setting of session.save_path is correct (/var/php_sessions) in Unknown on line 0