Stittsville Village Association

Application Form

STITTSVILLE VILLAGE ASSOCIATION
AWARD FOR EXCELLENCE IN CIVIC LEADERSHIP

The Stittsville Village Association (SVA), through its organization of community events and activities to foster community spirit and its representation of important community issues before various levels of government, recognizes the value and importance of citizen involvement in civic matters.
The SVA therefore proposes to encourage civic involvement and leadership at a high school level by presenting this award to deserving graduating students from each of the three high schools attended by the majority of our local students attend namely South Carleton, Sacred Heart and Frederick Banting Alternate Program.
This award will be unlike any other award presented at each school, specifically recognizing civic leadership.

Please complete this form and submit it by May 14 to:

Stittsville Village Association
Attention: Civic Leadership Award
PO Box 454
Stittsville, Ontario
K2S 1A6

Name:

Address :

Are you graduating this year from Grade 12?

Yes                No 

School Telephone Number:
If you need more space for a question, please use the reverse of this sheet or attach a separate sheet.
With what community organization have you been involved, such as the food bank, school, Stittsville Village Association, a service club, Church or religious institution, sports group?
 

Please provide details, including the amount of time and nature of your work:

 
In what ways do you see yourself contributing to your community in the future?
In your opinion, what makes a good community leader?

References:

Three references are required with details as outlined below. Each one should have given his/her consent in advance to serve as a reference for you.
1. A School Faculty Member:
  Name:   
  Telephone Number: 
  E-mail Address: 
       
2. A Work (paid or unpaid) Reference:
  Name:   
  Telephone Number: 
  E-mail Address: 
       
3. An Adult other than a family member:
  Name:   
  Telephone Number: 
  E-mail Address: 
       
The SVA thanks you for your interest in this award. You will be contacted if you are selected for an interview.

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