JUCHARTZ AWARD NOMINATION FORM

DONALD JUCHARTZ AWARD

FOR COMMITMENT TO EXEMPLARY COMMUNITY SERVICE

SCHOLARSHIP PURPOSE: Belleville Rotary's highest honor recognizes community members who demonstrate Rotary's motto, Service Above Self, by volunteering their time and talents to help others and who demonstrate an exemplary commitment to their community. This award is intended to especially recognize those who actively help others. This one-time Award is community competitive and is granted to no more than one community member who resides in the tri-community area or a senior 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 a community member beyond high school age who lives in the tri-community area who plans on attending an accredited vocational school, community college, college, or university the following fall.

HOW TO NOMINATE A CANDIDATE: Faculty, school administrators, coaches, school board members, any employee/volunteer of VBPS, tri-community business owners, members of the Belleville Chamber of Commerce, Belleville Downtown Development Authority, or any member of any governing body of the tri- communities may honor an exemplary person by nominating this person 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): *

clear

Faculty member	School administrator
Coach	School board member
Volunteer	Employee of VBPS
Business Owner	Chamber of Commerce
Downtown Development Authority	Government Official
Other Other