Name
___________________________________________________
Address _________________________________________________
City/State/ Zip____________________________________________
Home Phone Number_______________________________________
Date of Birth______________________________________________
Parish___________________________________________________
Parents Name_____________________________________________
Place of Service___________________________________________
Name of on-site director_____________________________________
Address_________________________________________________
City/State/ Zip____________________________________________
Phone Number____________________________________________
Description of nature of Service _______________________________
________________________________________________________
________________________________________________________
________________________________________________________
My son/ daughter has my permission to participate
in the St. Peter the Aleut Service Award Program.
___________________________________
Signature of Parent
I will assist and advise the applicant throughout
his/her project, or I will assign a qualified advisor.
_____________________________________
Signature of pastor
___________________________________
Signature of participant
Return
Completed application, together with a detailed essay
describing your project, the benefits you dervived
from it, etc to:
