COZADD AWARD NOMINATION FORM

CHARLES B. COZADD AWARD

FOR COMMITMENT TO EXEMPLARY SERVICE TO SCHOOL OR OTHER STUDENTS

SCHOLARSHIP PURPOSE: Belleville Rotary's highest honor recognizes students who demonstrate Rotary's motto, Service Above Self, by volunteering their time and talents to help others and commitment to their school and/or other students.

This award is intended to especailly recognize those who actively help others. This one-time Award is community competitive and is granted to no more than one student who resides in the tri-community area or who attends Van Buren Public Schools, for a total of $5,000, for educational purposes.

ELIGIBILITY: Graduating Senior who lives in the tri-community area (Belleville, Sumpter Twp., or Van Buren Twp.) or attends Van Buren Public Schools and who plans on attending an accredited vocational school, community college, college, or university the following fall.

HOW TO NOMINATE A CANDIDATE: Only faculty, school administrators, coaches, school board members or any employee/volunteer of Van Buren Public Schools may honor exemplary students by nominating a student for this award. One nomination per nominator.

DEADLINE FOR SUBMISSION: April 7, 2025

Nominee Information

First Name *

Last Name *

MI

Address 1 *

Address 2

City *

State *

Zip Code *

Phone *

Email Address *

The nominee is a graduating senior who lives in the tri-community or attends VBPS and who plans on attending an accredited vocational school, community college, college or university the following fall. *

Yes

No

Nominator Information

First Name *

Last Name *

MI

Address 1 *

Address 2

City *

State *

Zip Code *

Phone *

Email Address *

To nominate a student for this award you must be one of the following. Please indicate your role. (Choose one). *

Nominee Qualifications

General Biography: *

What colleges and universities has the student applied to? Which has the student been accepted to? *

What does the student want to study in college? *

What service/volunteer activities is the student involved in? *

How does your nominee show a commitment to other students and/or school (Limit to 1,000 words): *

What makes this person stand out from other candidates (Limit to 1,000 words): *

Describe how this candidate embodies Service Above Self (Limit to 1,000 words): *

Please feel free to submit the above answers as a word document or to upload any relevant attachments.

I certify that the above information is correct. (Please sign): *

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