TARA SAVIN SCHOLARSHIP PROGRAM 2013

TARA SAVIN SCHOLARSHIP PROGRAM 2013

Summerfuel Scholarship Program 375 West Broadway Suite 200 New York, NY 10012 T: 212.796.8340 F: 212.334.4934 [email protected]

Tara Savin Scholarship Program:

Tara Savin was a creative and dedicated leader with a passion for others. She graduated magna cum laude from Boston University and received a Master’s in Mass Communications from Boston University as well as a Master’s in Social Work from Fordham University. Tara loved education, politics and the arts and worked on many entrepreneurial and service projects. The Tara Savin Scholarship program aims to build on Tara’s hard work and equip young women with the skills to make a difference in their community and beyond. By attracting intelligent, creative, hard-working, and socially conscious students, we hope that we can produce a generation of leaders with the awareness and passion to build a better future. The Tara Savin Scholarship Program selects outstanding individuals to attend Summerfuel’s Social Entrepreneurship Program at Yale University on a full scholarship.

Eligibil ity: ASA welcomes any female student currently enrolled in the 9th, 10th or 11th grade in the United States to apply for this competitive scholarship. Successful applicants will have a demonstrated passion for community activism and/or entrepreneurship, serve as a leader in their high school community and beyond, and be in good academic standing (minimum GPA: 3.0). All applicants must be U.S. Citizens.

Application Components: q Completed Tara Savin Application Form with a recent photograph q Extracurricular Resume

Please include extracurricular activities, volunteer involvements, work experience, leadership experience, etc. q Two Letters of Recommendation (Academic and Personal)

Academic: completed by an instructor or advisor who can attest to your academic achievements and work ethic. Personal: may be completed by someone who can attest to your character and leadership ability. This may be a coach, religious

leader, boss, longtime family friend or anyone that knows you well. q Recent high school transcript (minimum 2.5 GPA) q Personal statement (500 words)

Please explain you interest in the program and how your participation will help you reach your academic and extracurricular goals. q OPTIONAL: Statements of financial status

i.e. school financial aid award letter, recent tax information, other scholarships awarded, special financial circumstances

Frequently Asked Questions What does the Tara Savin Scholarship include? The Tara Savin Scholarship is a full scholarship to attend Summerfuel’s Social Entrepreneurship program at Yale University. The scholarship includes full program tuition (including security deposit), full room & board, all included program trips & activities, and airport transfers to/from JFK. The scholarship does not included travel, optional extras, and spending money. Please consider these additional costs before applying for the Tara Savin Scholarship. What are my chances of being awarded a scholarship? Tara Savin Scholarship awards are competitive and, unfortunately, many strong applicants do not receive a scholarship. While we encourage you to apply, we ask that you manage your expectations.

I am applying for the Tara Savin Scholarship, should I submit a deposit? Program deposits become non-refundable on April 1st, but do not mail scholarship awards until April 15th. If your child will only be able to attend if she receives this scholarship, please do not send a deposit as we will not be able to return your deposit. If your child would still be able to attend without a scholarship award, you should submit a deposit to reserve a space in the program. Will there still be room in Summerfuel programs in April? While we reserve spaces in our programs for scholarship recipients, we cannot guarantee that there will be room for non-scholarship applicants in April.

Important Dates for 2013 March 15 APPLICATION DEAD LINE for Scholarships All application materials must arrive at our office (by mail or email) by this date. April 1 Program deposits become non-refundable. April 15 Scholarship decisions mailed to families. May 1 Scholarship must be formally accepted by this date. June 30 Social Entrepreneurship at Yale begins! September 1 All program follow-up materials are due to the Summerfuel office.

TARA SAVIN SCHOLARSHIP APPLICATION FORM

Applicant’s Name: _____________________________


I am applying for: ☐ Tara Savin Scholarship at Summerfuel Yale Student Information

Student’s Name FIRST LAST

Address STREET ADDRESS APT

CITY STATE ZIPCODE

Student Email Student Cell Sex: ☐ male ☐ female Date of Birth: (month/day/year) ____________________ Grade as of Jan. 2013: ☐ 9 ☐ 10 ☐ 11 US Citizen: ☐ yes ☐ no T-Shirt Size: ☐ s ☐ m ☐ l ☐ xl

School SCHOOL NAME CITY STATE/COUNTRY

How did you first hear about Summerfuel? ONLINE RECOMMENDATION SCHOOL ADVERTISEMENT ☐ web search ☐ summerfuel alumni ☐ teacher ☐ print

☐ web directory ☐ other ☐ guidance office ☐ internet

Please specify: Parent/Guardian Information Parent#1/Guardian’s Name Relationship to Student HM Tel WK Tel Cell Email Address (IF DIFFERENT FROM STUDENT)

Employer Annual Income (INCLUDING CHILD SUPPORT) Parent#2/Guardian’s Name Relationship to Student HM Tel WK Tel Cell Email Address (IF DIFFERENT FROM STUDENT)

Employer Annual Income (INCLUDING CHILD SUPPORT)

Student lives with (check all that apply): ☐ mother ☐ father ☐ stepmother ☐ stepfather ☐ custodial parent(s) ☐ other relationship Check if appropriate: ☐ mother is deceased ☐ father is deceased ☐ parents are separated ☐ parents are divorced

☐ other. please explain __________________________________________________________________


Applicant’s Name: _____________________________


Household Information

Do you rent your home? ☐ yes ☐ no If yes, monthly rental cost $________________ Do you own your home? ☐ yes ☐ no If yes, current market value $________________ Monthly mortgage $_________________ Do you own other real estate? ☐ yes ☐ no If yes, current market value $________________ Monthly mortgage $_________________ Property’s yearly income (if property is income producing) $_________________

Vehicle Information

Vehicle #1 Make ________________________________ Model ________________________________ Year ___________________ Vehicle #2 Make ________________________________ Model ________________________________ Year ___________________ Vehicle #3 Make ________________________________ Model ________________________________ Year ___________________ Dependents

_______________________________ _________ ______________________________________ ☐ Public ☐ Private ____________________ NAME OF STUDENT APPLICANT AGE SCHOOL ATTENDING TUITION/FEES PAID BY FAMILY

_______________________________ _________ ______________________________________ ☐ Public ☐ Private ____________________ NAME OF CHILD/DEPENDENT AGE SCHOOL ATTENDING TUITION/FEES PAID BY FAMILY

_______________________________ _________ ______________________________________ ☐ Public ☐ Private ____________________ NAME OF CHILD/DEPENDENT AGE SCHOOL ATTENDING TUITION/FEES PAID BY FAMILY _______________________________ _________ ______________________________________ ☐ Public ☐ Private ____________________ NAME OF CHILD/DEPENDENT AGE SCHOOL ATTENDING TUITION/FEES PAID BY FAMILY

Parent/Guardian Financial Assets Please list all financial assets such as stocks, bonds, savings accounts, CDs, money market funds, trusts, second homes, boats, motor homes, etc. ____________________________________ ______________________ ___________________________________ _____________________ ASSET VALUE ASSET VALUE ____________________________________ ______________________ ___________________________________ _____________________ ASSET VALUE ASSET VALUE _________________________________________________________________________________________________ _____________________ ASSETS IN STUDENT’S NAME (STOCKS, BONDS, SAVINGS ACCOUNTS, CDs, MONEY MARKET FUNDS, TRUSTS, COLLEGE FUNDS, ETC) VALUE _________________________________________________________________________________________________ _____________________ ASSETS IN STUDENT’S NAME (STOCKS, BONDS, SAVINGS ACCOUNTS, CDs, MONEY MARKET FUNDS, TRUSTS, COLLEGE FUNDS, ETC) VALUE

Sponsoring Agency (IF APPLICABLE) If you are working with a sponsoring agency, school, or guidance counselor, please write the name of that agency below.

Agency Contact

Special Circumstances Below, or on a separate sheet, please detail any extraordinary circumstances (such as medical expenses, outstanding loans, recent layoffs, etc.) that we should consider during our reading of this application.

Financial Documentation (OPTIONAL) Please provide any supporting documentation that will help us determine your family’s financial need (i.e. school financial aid award letter, recent tax information, other scholarships awarded, special circumstances, etc). Please do not send originals; we are not able to return any application materials.


Applicant’s Name: _____________________________


Additional Information

Do you have a medical condition that might interfere in your participation in a Summerfuel program? ☐ yes ☐ no Do you have any dietary needs that require special attention? ☐ yes ☐ no

If you answered “yes” to the above, or if you have any educational, social, personal or psychological needs that may require special attention, treatment or medication, please enclose a full report and any supporting documentation.

Have you ever been involved in any disciplinary action in your school? ☐ yes ☐ no If yes, please attach an explanation. Participant’s Agreement

I understand that I will be sent a detailed copy of ASA’s rules, regulations & responsibilities as soon as my application has been accepted and I acknowledge that ASA or its agents has the right to dismiss me and return me home at my own expense without refund of the program fee, should I be found in violation of these rules. Student Signature Date

Parent/Legal Guardian Agreement

I have read the ASA brochure and hereby give permission for my child/ward to participate in the ASA program during the summer of 2013 at the location indicated on the application. By execution of the application and this Agreement, I confirm my awareness and acknowledge the risks of injury which may be associated with travel, particularly in foreign countries. My child/ward is enthusiastic and prepared, and I believe he/she is capable of handling both the emotional and physical aspects of the program as well as any risks involved. Furthermore, I agree that, should my child/ward’s conduct, at the sole discretion of ASA, be deemed to be in violation of ASA rules or otherwise detrimental to the maintenance of standards or to the successful operation of ASA’s program, ASA, in its sole discretion, may dismiss him/her from the program. I further agree that ASA shall have no further responsibility for my child/ward upon his/her dismissal from the program, and I understand that such dismissal may occur at a location far from the child/ward’s home. I affirm that ASA shall have the exclusive authority to determine the manner and means of transporting my child/ward home without supervision, and that all additional expenses (including but not limited to the entire costs of the transportation) shall be borne completely by me, and that ASA shall have no obligation to provide any refund of the tuition fee with respect to any dismissed student. Notwithstanding the foregoing, in the event ASA elects to send my child/ward home with a supervising ASA representative, all expenses of such ASA representative (including but not limited to the entire costs of the transportation) shall be borne completely by me. Prior to the commencement of the program, I shall sign a credit card authorization to be held by ASA authorizing the payment from my credit card of any such expenses of my child/ward and the ASA representative in the event of the dismissal of my child/ward. I have read the payment policy and refund schedule in the general information section of this brochure and agree to the terms cited. I understand and acknowledge that no refunds are available for any cause, and that trip insurance is recommended. It is understood that ASA may make use of students’ photographs and testimony in publicity materials, including the brochure, poster and website, without payment of any consideration, and I hereby grant ASA permission for such use. Furthermore, in applying for an ASA program, I hereby understand and accept the following terms and conditions, the violation of which may result in my child/ward’s dismissal, without further notice: • The possession or use of drugs or alcohol is strictly prohibited. • All participants must adhere to all rules of safety and conduct at all times, including those promulgated by ASA, the educational institution and the jurisdiction where the educational institution is located. • Any violation of the rules, terms or conditions, as well as behavior incompatible with the programs, could result in dismissal of a student at parent’/guardian’ expense as stated above. I authorize ASA, at its sole discretion, to place my child/ward at my own expense and without any further consent or advance notice in a hospital for medical services and treatment or, if no hospital is readily available, to place my child/ward in the care of a licensed medical doctor for treatment. I hereby grant ASA full authority to take whatever actions it may reasonably consider to be warranted under the circumstances. Child/Ward Name (PRINT) Parent/Legal Guardian Name (PRINT) Relationship to Student Parent/Legal Guardian Signature Date


Applicant’s Name: _____________________________


Student/Guardian Scholarship Application Agreement I, the undersigned parent/legal guardian, hereby apply my child for the Tara Savin Scholarship. Scholarship decisions will be made by May 1, 2013. By the time awards are made, spaces may only be available for scholarship recipients. Should I choose to register my child for the program now (by sending in a full deposit) in addition to applying for a scholarship, and my child does not receive a scholarship award, I will assume full responsibility for paying the program’s entire tuition in full by May 15, 2013. Sending in a deposit guarantees a space at the program – so long as spaces are still available – regardless of the outcome of scholarship decisions. Should I choose to register my child with a deposit, and then decide at a later date to withdraw my child, I understand that the program deposit is non-refundable after April 1, 2013. If my child and I accept a scholarship award, the Tara Savin Scholarship Agreement mailed with award notification must be returned to the office by May 1, 2013. I also understand that any additional costs associated with the Tara Savin Scholarship (such as travel to/from program, optional extras and spending money while on program) will be my responsibility. I agree to submit all additional critical paperwork in a timely manner in preparation for the start of the program. I understand that my child’s scholarship may be revoked for any of the following reasons: evidence of misconduct including violation of any of the rules that could result in my dismissal from the program; failure to submit required materials on time; failure to follow the directions of the Scholarship Committee or a member of Summerfuel staff member; or any contingency that prevents me from fulfilling all the obligations of the scholarship. I understand that revocation of a scholarship may make me liable for the full amount of the program tuition. I have read and understand the above statements. I have filled out the Tara Savin Scholarship Application Form as completely as possible, and the information is accurate to the best of my knowledge. Parent/Legal Guardian Name (PRINT) Relationship to Student Parent/Legal Guardian Signature Date

If I, the undersigned student applicant, am awarded a scholarship, I agree:

Upon completion of the program, to turn-in a post-program reflection essay of at least 500 words, reflecting on my experience on the program and any memorable experiences and be available to discuss overall program satisfaction.

To serve as a Summerfuel Ambassador to my community by serving as a reference to prospective Summerfuel students by answering

questions via email or phone and attending local informational meetings if possible.

To permit Summerfuel to use my name, all photographs, and any written reports generated through my participation in SE Yale.

That my scholarship may be revoked for any of the following reasons: evidence of misconduct including violation of any of the rules that could result in my dismissal from the program; failure to submit required materials on time; failure to follow the directions of the Scholarship Committee or a member of Summerfuel staff member; or any contingency that prevents me from fulfilling all the obligations of the scholarship. I understand that revocation of a scholarship may make my guardian liable for the full amount of the program tuition.

I have read and understand the above statements. I have filled out the Tara Savin Scholarship Application Form as completely as possible, and the information is accurate to the best of my knowledge. Student Applicant Name (PRINT) Student Applicant Signature Date

Please send completed applications to:

Summerfuel Scholarship Program 375 West Broadway, Suite 200

New York, NY 10012

[email protected]

All application materials due by March 15, 2013

Documents

TARA SAVIN SCHOLARSHIP PROGRAM 2013