ESSAY FORM THE MARTIN LUTHER KING, JR. HUMANITARIAN AWARD 2015 Baldwin Middle School – Baldwin, New York Sponsored by: The Concerned Parents of Baldwin, Inc. The Concerned Parents of Baldwin (CPOB) grants its annual HUMANITARIAN AWARD to a Baldwin Middle School student who exemplifies the ideals of Dr. Martin Luther King, Jr. The nominee should promote brotherhood and peace among their fellow students and portray the ideals of freedom and responsibility through their actions. Our theme this year is “Dr. King: Standing Up Against the Hate.” DIRECTIONS:

1. 2. 3. 4.

Go to our website: www.concernedparentsofbaldwin.org Download the application forms: the ESSAY FORM and REFERENCE FORM. Print 3 copies of the REFERENCE FORM to give to the 3 persons who will fill out the recommendations. Once the recommendations are completed and returned to you, attach the ESSAY FORM to the 3 REFERENCE FORMS along with your RESUME, and submit the completed package to your Guidance Counselor. The completed package must include the application essay, a resume, and three references (one from a teacher, one from an extracurricular advisor and one from a community person not affiliated with Baldwin Middle School). Your references are being asked to give a candid estimate of your personal qualities to help the committee make its final decision.

5. The Humanitarian Award application is due by December 12, 2014. No applications will be accepted beyond this date. Student Name: [First, Middle, Last]

Home Address: [House or Apt#, Street, City/Town]

Telephone: e.g.(516) 555-5555 (___) ___ - ____

Grade:

Guidance Counselor:

In what ways have you contributed to Dr. Martin Luther King’s dream of “Standing Up Against the Hate”? Describe how you have demonstrated an awareness and sensitivity toward others through your participation in school, community activities and organizations. Essay should be no longer than 500 words. Font size should be 10 to 12 point, not script.

REFERENCE FORM DR. MARTIN LUTHER KING, JR. HUMANITARIAN AWARD BALDWIN MIDDLE SCHOOL Student’s Name__________________________ Grade__________

Rating Guide

A=Always S=Sometimes

_____Teacher _____Extracurricular advisor _____Community leader

O=Often NA= Not Applicable A

O

S

NA

Dependable Cooperative with teachers Cooperative with students Self-reliant Ambitious Courteous Friendly Involved in extracurricular activities Interested in the welfare of others Establishes relationships with students of other ethnic groups Respected by peers Responsible Performs at satisfactory scholastic level Advances the concept of brotherhood by example and actions Involved with elementary and middle school students Involved in the community What are your impressions of the applicant’s character, aims and values?___________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ Please provide specific examples of applicant’s contribution.______________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ Involvement or relationship with applicant.____________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________

__________________________ Print Name of Reference

___________________________ Signature of Reference