Montgomery Elementary Home and School
2015-2016 Alumni Award Application
(application must be typed)
Student Name
First:___________________________MI:__________Last:____________________________________
Student’s Date of Birth: __________/__________/__________
Sex: M _____
F _____
Student’s Address: ___________________________________________________________________________
City: ____________________________________________________State:_____________Zip:_______________
Student’s Home Phone Number: ___________________________________________________________
Years of attendance at Montgomery Elementary:_________________________________________
Parent/Guardian Name(s): _________________________________________________________________
State a possible college major, profession or career:______________________________________
For the following statements, list your activities and the grade that you participated
in each – limit your list to grades 10-12.
Extra-curricular Activities/Sports in or out of school:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Club Memberships:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Community Service / Volunteer Activities:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Work Experience:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Special Recognitions, Honors, or Awards for academics or any other special
achievements:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
I hereby certify that all of the information on this form
is true and accurate to the best of my knowledge.
Please submit by March 14, 2016
Applicant’s signature:________________________________________________________________________
Parent’s signature: __________________________________________________________________________
Guidance Counselor’s Signature:___________________________________________________________