Gray Panthers of South Dade
Age and Youth in Action
P.O. Box 960657.
Miami, FL 33296-0657
Ph. 305.331.2264
March 7, 2017
Enclosed please find a copy of the Gray Panthers of South Dade Al
Afterman Scholarship Application. This scholarship is made available to high
school seniors who have made a commitment towards fostering intergenerational
service-learning activities.
The Gray Panthers is a national organization of intergenerational
activists dedicated to social and economic justice. For over 30 years, Gray
panthers have worked to make our nation one that lives up to its dreams and
promises of fair and just treatment for all. Founded in 1970 by social activist
Maggie Kuhn, the Gray Panthers have active networks coast to coast working for
progressive change through civic engagement in communities and the nation at
large.
The members of The South Dade Gray Panthers have donated money to
establish yearly scholarships, in the amount of $500 each, for deserving youth
who have volunteered their time towards enhancing relationships and activities
that unite young people and elders in the community. We hope that you will
assist us in distributing applications to students you feel meet this
criterion. Scholarships will be awarded on Saturday, May 20, 2017 at the Gray
Panthers of South Dade Membership Meeting.
Completed applications must be received no later than April 28, 2017
and mailed to:
The Gray Panthers of South Dade
Post Office Box 960657
Miami, Florida 33296-0657
Thank you for your assistance in our goal to recognize deserving
youth. If you have questions or need additional information, please contact Dr.
Ramona Frishman at
305.331.2264.
APPLICATION
DEADLINE
NO
LATER Than Friday, April 28, 2017
Applications
must be received by April
28, 2017
AWARDS
WILL BE GIVEN OUT ON SATURDAY, MAY 20, 2017 
Gray Panthers of
South Dade
Al Afterman
Scholarship Application
The Gray Panthers of South Dade
Post Office Box 960657
Miami, Florida 33296-0657
Scholarship Application for graduating
high school seniors. (Please type or print clearly)
I. Personal
Information – Part One
Date: ______________ Phone: ________________________ Cell: ___________________
Name:
________________________________________________________________________
Address:
______________________________________________________________________
City: ____________________________ State: _______ Zip Code: ____________________
County: __________________ E-Mail:
____________________________________________
II. Personal
Information – Part Two
Date of Birth:
__________________________________________________________________
Gender: Male __________ Female __________
III. Current
Education Institution
Name of High School You Are
Presently Attending: ___________________________________
School Address:
_______________________________________________________________
City:________________________________State:_________________Zip
Code:____________
City:
____________________________ State:
________ Zip Code: ___________________
IV. Plans
for Continuing Your Education
Please List Below the Appropriate
School(s) Where You Have Been Accepted.
Technical/Vocational
School: _____________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Community
College: ____________________________________________________________
____________________________________________________________________________________________________________________________________________________________
Four-Year University:
___________________________________________________________
____________________________________________________________________________________________________________________________________________________________
V. Plans
for the Future
What are your
future plans upon graduation from college? (Your
answer length may be as long or short as you feel necessary to answer the
question.)
_________________________________
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
(Attach a separate page if more space is
necessary.)
VI. Involvement with
Intergenerational Programs
Please write about your
involvement in intergenerational activities. Give examples of activities, in
which you have participated, that involve youth
and older adults together. (For instance: Participating in an Oral History
Program by interviewing World War II veterans; working with local senior
citizen centers to develop activities for elders; teaching computer skills to
elders, etc.) Why do you feel that these types of programs are important to
both generations? (Your answer length may
be as long or short as you feel necessary to answer the questions.)
______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
(Attach a separate page if more space is
needed)
VII. Leadership and Participation
in Other Community Activities &
Volunteer Services (Attach a separate page if more space
is necessary.)
Activity Date(s) Position
(if an officer)
_______________________ _____________ ______________________________
________________________ _____________ ______________________________
_________________________ ______________ ______________________________
_________________________ _______________ ______________________________
_________________________ ________________ ______________________________
_________________________ ________________ _____________________________
VIII. References
1) Name: ___________________________________ Phone: _______________________
Address:
________________________________________________________________
City:
___________________________ State:
_________ Zip Code: _____________
Relationship:
______________________________________
Years Known: ________
2) Name: ___________________________________ Phone: _______________________
Address:
________________________________________________________________
City:
___________________________ State:
_________ Zip Code: _____________
Relationship:
______________________________________
Years Known: ________
IX. Attach a letter of recommendation
from one of the following: a Teacher,
Guidance Counselor or Principal.
X. Affirmation
I affirm that all of the information I have provided on, or with, this
application is accurate.
_________________________
__________
________________________ _________
Applicant’s Signature Date Signature of
Parent/Guardian Date
Note: Please do not send transcripts
