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AAA Public Affairs Department
1 Auto Club DriveDearborn, MI 48126
Student CertificationI certify that the application submitted meets with the rules and conditions of the AAA School Safety Patrol Scholarship in Michigan. I agree by signing below that I have abided by the rules and give consent for my name, likeness, and/or photograph to be used without compensation in all promotional materials concerning this scholarship. I understand that the decision of the scholarship committee is final in all respects. I hereby acknowledge that all materials submitted will become the property of AAA–The Auto Club Group.
Student Information
This form may be photocopied.
AAA School Safety Patrol Scholarship Application
18-T
F-0020
Name: ________________________________________
School: ________________________________________
Birth Date: _____________________________________
Phone: ________________________________________
Home Address: __________________________________
City: __________________________________________
State: _____________________ Zip: _______________
Email: _________________________________________
Signatures
Student: _______________________________________
Parent/Legal Guardian: ____________________________
Date: _________________________________________
AAA School Safety Patrol® Michigan
Scholarship Application
Guidelines• Applications must be postmarked on or before
• Applications are limited to one per school.• Applications are the property of AAA–The
Auto Club Group and will not be returned.• By submitting the scholarship application,
participants expressly agree to the rules andthe decisions of the Committee.
• The scholarship recipients are the only studentswho will receive a notification letter. The letterwill be sent no later than
• Scholarships will be awarded in the name of thestudent and the institution of higher learning.
• Scholarship recipients must provide proof ofacceptance to an accredited institution ofhigher learning.
• Scholarships are not transferable or redeem- able for cash at any time.
• Scholarship must be claimed by
• Recipient should check with a tax advisor re- garding the possible tax implications of this gift.
Selection Procedure• The AAA School Safety Patrol Scholarship
Committee in Michigan will determine thewinning recipients.
• AAA–The Auto Club Group reserves the rightto modify or terminate the AAA School SafetyPatrol Scholarship Program at any time.
• Children and family members of AAA–TheAuto Club Group employees, officers andboard members are not eligible (includinggrandchildren, nieces, nephews etc.).
p A personal letter of introduction describing community involvement, extra-curricular activities and what being part of the AAA School Safety Patrol program has meant to you.
p A letter of recommendation from a school official AND a letter of recommendation from a community representative. Ex: teacher, counselor, principal, youth leader, employer or other.
p A copy of junior year transcript documenting a minimum 3.0 GPA.
p A copy of exam results of ACT with a minimum score of 21 or SAT with a minimum of 950.
p Proof of AAA School Safety Patrol participation in Michigan, verifying service in good standing; such as a letter from an elementary school principal, copy of AAA School Safety Patrol certificate, etc.
p Signature of parent/legal guardian and school counselor.
Please provide the following information along with the documents listed in the Documentation section of this form.
AAA School Safety Patrol School:
____________________________________________ School Year Served:
____________________________________________ Name of college/institute applicant plans to attend:
____________________________________________Planned field of study:
____________________________________________ Signature of current principal/counselor:
____________________________________________Printed name of current principal/counselor:
____________________________________________
Date: ________________________________________
Please return this application to your school’s Counseling/Guidance Office no later than DO NOT send this to AAA. The school will be responsible for submitting their selected nominee application by
____________________________________________
For Counseling/Guidance Office use only: Send submissions to: Electronically (preferred method via scan/email): [email protected] or
Mail: AAA Public Affairs Department Scholarship Applications 1 Auto Club Drive Dearborn, MI 48126Questions/comments: [email protected]
(Continued from other side)
Two $2,500 scholarships will be awarded to graduating seniors who served as AAA School Safety Patrol® members in Michigan. Students must submit documentation of AAA School Safety Patrol participation, good academic standing and a strong record of participation in the community and extra-curricular activities.
RequirementsAll applicants must be a graduating high school senior from a public or parochial high school or private preparatory school within AAA – The Auto Club Group service area in Michigan. This includes reasonable and non-discriminatory rules and regulations as developed by the Committee and accepted by an institution of higher learning.
DocumentationAll applications must provide:
AAA School Safety Patrol Scholarship Application
