Doneta Schaeffer Memorial
Scholarship Application

Complete this application, three letters of reference (see below), required documents listed in the criteria (below), and click the submit button at the bottom of this page to email this form to: Recognitions@GSEIWI.org. You can also fill it in, print it out and mail to:

Attn: Doneta Schaeffer Scholarship,
GSEIWI,
2011 Second Avenue,
Rock Island, IL, 61201.

All applications and letters must be received or postmarked no later than March 1, 2012. Incomplete or late applications and letters will not be considered. Applicants will be interviewed by a committee of Girl Scout volunteers
by April 30, 2012.

You will be notified by mail of your application status with further
information if needed.

Doneta Schaeffer was a Girl Scout volunteer and council staff member who believed that there was always something new to learn, different things to see, and more fun to experience. Those who knew her mourned her unexpected death in 1991, but also rejoiced in the memories and examples of a life full of learning and giving that Doneta left for us.

The annual Doneta Schaeffer Memorial Scholarship was established to help all of us—girls and adults—remember and renew this legacy at least once a year. Designed to help the recipient further her education, the $1,000 scholarship is given to a Girl Scout who exemplifies the ideals that Doneta held dear.

Candidate Information

** Means manditory information- you must fill in that field.

** Name of Candidate
** Street Address (include apt #)
** City ** State ** Zip
Email Address
Phone (day) Phone (evening)
High School Name Graduation Date
High School Address
City State Zip

** Means manditory information- you must fill in that field.

Girl Scout Membership History:
Daisy (grades K-1):
    Years Registered     Council
Brownie (grades 2-3):
   Years Registered     Council
Junior (grades 4-5):
   Years Registered     Council
Cadette (grades 6-8):
    Years Registered     Council
Senior (grades 9-10):
    Years Registered     Council
Ambassador (grades 11-12):
    Years Registered     Council
College/ University/ Technical Schools Applied to:
Response (if known)
College/ University/ Technical Schools Applied to:
Response (if known)
College/ University/ Technical Schools Applied to:
Response (if known)
** Gold Award Project Description:

** Year Completed

Award criteria and checklist or Criteria
for Selection Checklist: All steps must be completed.

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** Means manditory information- you must fill in that field.

** The applicant is a registered Girl Scout of the Girl Scouts of Eastern Iowa and Western Illinois Council.
** The applicant has at least 5 years of experience in Girl Scouting, with two of those years in grades 10-12.
** The applicant has earned the Girl Scout Gold Award, the highest honor for Girl Scouts.
** The applicant has demonstrated a commitment to living by the Girl Scout Promise and Law.
** The applicant is a high school senior, with graduation occurring the present school year.
** The applicant has at least a 2.5 grade point average (GPA.)
** The applicant has applied to a college or technical school.
** Emailed the following materials to: Recognitions@gseiwi.org

Application Essay
Copy of Gold Award Project Report Form
Copy of high school transcript, verified by school counselor or administrator

** Answer the following questions:

    ** Why did you want to earn the Girl Scout Gold Award?

    ** In what ways did your project have an impact on you? On others?

    ** In what ways did you give of yourself in doing your project?

    ** In what ways have you, as a Girl Scout, contributed to the well-being of your community?

    ** What have you discovered about Girl Scouting and how have you shared it with others?

    ** Why do you believe it is important for you to be a Girl Scout?

    ** What, if anything, have you sacrificed in order to be a Girl Scout?

    ** How do you think you may continue your involvement in Girl Scouting?

Reference Information

** Means manditory information- you must fill in that field.

This application must be accompanied by three additional letters of reference: two references document the applicant's community involvement (including participation in school or spiritual groups) and one reference documents the applicant's Girl Scout experience. References must be new for this application. Only one reference can be from a peer/girl. References from relatives are not accepted.

Community Involvement Reference:
** Name
** Phone
Email Address

Community Involvement Reference:
** Name
** Phone
** Email Address

Girl Scout Experience Reference:
** Name
** Phone
Email Address

NOTE: References for Community Involvement and Girl Scout Involvement forms are available in a separate fillable online form.

If you would like to print or save a copy for yourself, you must do so before submitting.
Click on the printer icon on the top right of your webpage to print or go to file and save as.

Press the submit button to email your application.
Please review your information before submitting.

Doneta Schaeffer Memorial Scholarship Application

Candidate Information

Award criteria and checklist or Criteria for Selection Checklist: All steps must be completed.

Reference Information

Doneta Schaeffer Memorial
Scholarship Application

Award criteria and checklist or Criteria
for Selection Checklist: All steps must be completed.