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Council of School Supervisors and Administrators40 Rector Street, 12th Floor, New York, NY 10006-17292021 STUDENT SCHOLARSHIP APPLICATIONCSA will award $3,000 to one student from each borough. The scholarship will be awarded June 2, 2021 during the final CSA Chair and Executive Board Zoom Meeting. The applications are due to the Principal or Assistant Principal no later than Friday, March 5, 2021.Please print or type the following information:First Name: _______________________ Last Name_____________________________DOB: _____/_____/_____Gender: M________ F_________Home Address: _________________________________________________City: ___________________________________State: ___ Zip: ___________Home Phone: (____) _____-________E-mail address: _________________@_______________________High School Name: ________________________________________________________School Borough: ______________Principal’s Name: _____________________________________________Graduation Date: ____/_____College you plan to attend: ________________________________________________ List activities outside of school, including jobs and volunteer work:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________List activities in school, such as clubs, teams, etc.:__________________________________________________________________________________________________________________________________________________________________________________________________________________ ______________________________________________________________________ Name and title of the supervisor who will sign the Supervisor Verification Form: Name _____________________________________Title ___________________________Student Signature ________________________________________________ Date _____/_____/_____2021 STUDENT PERSONAL STATEMENTSRespond to the following questions in a typewritten, double-spaced format that does not exceed two pages for each question. All three questions must be answered; your total response should not be more than six pages. Identify three essential characteristics of leadership that you have demonstrated in and outside of your school? Please give specific examples for each characteristic. Identify someone who has influenced you in a profound way and describe how they did so.How will a college education help you achieve your personal and career aspirations? ................
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