Choose to Include Scholarship!

Amount of Scholarship Award: $500

Additional Recognition: Recipient(s) will be invited to attend Unified Champion Schools Youth Activation Summit annually. The details of their nomination may be kept private per request.

Eligibility Requirements: High school freshman, sophomore or junior

Considerations: Demonstrate commitment to an inclusive community and/or bullying prevention in their school and community.

Scope: At least one scholarship will be granted to a student at Peotone High School, Lincoln-Way East High School, Lockport Township High School and from a Unified Champion School. Additional schools will be added per donor request.

Qualified Applicants:

Must be a high school freshman, sophomore or junior.
Must attend Peotone High School, Lincoln-Way East High School, Lockport Township High School or a Unified Champion School .
Must be nominated by a member of staff/faculty of student High School or Special Olympics Illinois or by a parent of a Special Olympics Illinois athlete.
Demonstrates commitment towards building an inclusive culture and/or bullying prevention in their school and community.

Today's Date*

Student Contact Information

Name*

First Last

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Email*

Phone*

Parent/Guardian Contact Info

Name*

First Last

Email*

Phone*

High School Information and More

Name of High School*

High School

List of Extracurricular Activities in High School*

Anticipated College or University*

Name of University

Anticipated Major*

Field of Study Being Pursued

Recommendation Letter Info and Essay

School Staff or Unrelated Adult Writing Letter*

Full Name Email Address Phone Number

Upload Recommendation Letter Here*

500-1000 Word Essay*

•Describe how your accomplishments relate to the mission of creating an inclusive community and/or ways you have proactively helped to lessen all forms of bullying within your school community and additionally reflect on the impact of your actions to your classmates, community and/or yourself.

Social Media (Optional)

Link to your social media profile:

If you choose to do so, please insert a link to your preferred social media platform. (Facebook, Twitter, or Instagram)

Final Statement

Would you like to keep your terms of nomination private?*

Yes
No

Scholarship Terms and Conditions:

To the best of my knowledge and belief, there is no reason that would prevent my being eligible to receive the above-named scholarship. The Special Olympics Illinois Foundation, its Scholarship Committee, and its staff, have my permission to review my academic information and documents for the purposes of verifying my eligibility for this scholarship.

Have you read the above statement and do you accept the terms?*

I have read and accepted the above statement and understand that incomplete applications will not be considered.
I have not read nor accepted the above statement.