Kristin Appelget Civic Engagement Student Awards Program

2011 Application Form

Student Awards Program Overview
The Kristin Appelget Civic Engagement Student Awards Program is named for the former CEO & President of the Princeton Regional
Chamber of Commerce and its Foundation who served from 2003-2006. The award will honor young people who have made outstanding
contributions to their communities by working or volunteering through civic, school, religious, political and other organizations.

The Princeton Regional Chamber of Commerce Foundation will honor up to four college bound high school juniors currently attending
high school in the Princeton region, including public and private school students and home-schooled students. The Princeton Region, as
defined for this student awards program, includes the school districts within Cranbury, East Windsor, Ewing, Hamilton, Hightstown,
Hopewell Borough, Hopewell Township, Kingston, Lawrence, Montgomery, Pennington, Plainsboro, Princeton Borough, Princeton
Township, Robbinsville, Rocky Hill, Skillman, South Brunswick, Trenton, Upper Freehold and West Windsor.

Candidates for the award must complete the attached form, provide an essay outlining their volunteer experience and how it impacts their
future plans, and provide one letter of recommendation. Eligible candidates include juniors who are pursuing a path of continued
education at a university, college, junior college, community college or vocational/technical institution.

The Princeton Regional Chamber of Commerce Foundation seeks to reinforce the goals of civic engagement and civic participation by
acknowledging the contributions of young people. The Foundation seeks nominations and applications from high school juniors who have
made a significant contribution to their communities, have established leadership in their civic activities and have demonstrated a sustained
commitment to their communities.

Definitions of Civic Engagement

“...individual and collective actions designed to identify and address issues of public concern. Civic engagement can take many forms, from
individual voluntarism to organizational involvement to electoral participation. It can include efforts to directly address an issue, work with
others in a community to solve a problem or interact with the institutions of representative democracy.”
Source: Michael Delli Carpini, Director, Public Policy, The Pew Charitable Trusts

“Civic engagement means working to make a difference in the civic life of our communities and developing the combination of knowledge,
skills, values and motivation to make that difference. It means promoting the quality of life in a community, through both political and
non-political processes… A morally and civically responsible individual recognizes himself or herself as a member of a larger social fabric
and therefore considers social problems to be at least partly his or her own; such an individual is willing to see the moral and civic
dimensions of issues, to make and justify informed moral and civic judgments, and to take action when appropriate.”
Source: Civic Responsibility and Higher Education, edited by Thomas Ehrlich, published by Oryx Press, 2000.

Princeton Regional Chamber of Commerce Foundation Mission Statement

The Princeton Regional Chamber of Commerce Foundation, a 501(c)(3) charitable organization, exists to effectively focus the skills and
resources of the greater Princeton business community on the critical civic, educational, scientific, cultural and economic development
interests of the region we serve.

Who We Serve:
 Individuals and businesses who recognize the importance of effective corporate and private citizenship and who are committed to the
development of their leaders;
 Non-profit and local government boards, committees, councils, and commissions who are in need of a diverse, skilled, knowledgeable
and passionate pool of community leaders;
 Established and emerging business, academic, non-profit, and local government leaders throughout the greater Princeton region.

Privacy Disclaimer
All information requested on this nomination form will be kept confidential within The Princeton Regional Chamber of Commerce
Foundation and evaluators. The Princeton Regional Chamber of Commerce Foundation will use reasonable efforts to protect the personal
information you provide from unauthorized use, disclosure, alteration or destruction.

Application Submission Deadline: Friday, April 1, 2011 - 4:00 pm

 To be filled out by the applicant
Please note that the information provided on this page will not be presented to the award review
committee. It is strictly for statistical reporting and logistical needs.

Last Name: __________________ First Name: _________________ Initial: ___

Address: ___________________________________________________________
City: ____________________________ State: ________ ZIP: ________________
Phone: (_____) ____________________
Email: ____________________________________________
Date of Birth: ____ / ____ / ____
Gender (optional): ___ Female ___ Male
Race (optional): ___ African American ___ Asian American ___ Native American
___ White ___ Hispanic ___ Multi-Racial ___ Other
High School: _______________________________________________________
City: _______________________________ State: ____
Current cumulative grade point average: ________
GPA Scale (circle one): 4.0 4.5 GPA Weighted? (circle one): Yes No
Expected date of graduation: ____ Month _____ Year
Contact Information for Letter of Recommendation
Last Name: __________________ First Name: _________________ Initial: ___
Company/Organization: ______________________________________________
Address: ___________________________________________________________
City: ____________________________ State: ________ ZIP: ________________
Phone: (_____) ____________________
Email: ____________________________________________

For Office Use Only

Application Code: _______________
Please describe any civic engagement, community or volunteer activities you have participated in during
the past four years, including year(s) and length of service. Indicate any positions of leadership you have
held and special awards or honors you have received. Please list specific activities you played a direct role
in rather than a general description of the organization’s activities. (Use additional sheets if needed.)

Name of Organization: __________________________________ City, State: _______________________

Organization Contact Name: _____________________________ Contact Number: _________________
Organization Contact E-Mail: _____________________________________________________________
Leadership Positions held: ________________________________________________________________
Activities:_______________________________________________________________________________
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Name of Organization: __________________________________ City, State: _______________________

Organization Contact Name: _____________________________ Contact Number: _________________
Organization Contact E-Mail: _____________________________________________________________
Leadership Positions held: ________________________________________________________________
Activities:_______________________________________________________________________________
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Name of Organization: __________________________________ City, State: _______________________

Organization Contact Name: _____________________________ Contact Number: _________________
Organization Contact E-Mail: _____________________________________________________________
Leadership Positions held: ________________________________________________________________
Activities:_______________________________________________________________________________
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Name of Organization: __________________________________ City, State: _______________________

Organization Contact Name: _____________________________ Contact Number: _________________
Organization Contact E-Mail: _____________________________________________________________
Leadership Positions held: ________________________________________________________________
Activities:_______________________________________________________________________________
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For Office Use Only

Application Code: _______________
Write a brief essay (200-300 words) on your civic engagement goals as they relate to your
education, career, future leadership roles and your involvement in the community.
(Use additional sheets if necessary or submit typed copy.)
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For Office Use Only

Application Code: _______________
 Application Submission Deadline: Friday, April 1, 2011 - 4:00 pm
This award application form becomes complete only if you have enclosed the following
materials:

 Award Application Form

 Essay on Goals and Aspirations (200-300 words)
 Letter of Recommendation

We encourage you to submit any and all documents via email, if possible.

EMAIL: Adam Perle, adam@princetonchamber.org

MAIL:
Princeton Regional Chamber of Commerce Foundation
Attn: Adam Perle
Vice President
9 Vandeventer Avenue
Princeton, NJ 08542

CERTIFICATION

I certify that the information provided is complete and accurate to the best of my
knowledge.

Applicant’s Signature _______________________________________ DATE __________

For Office Use Only

Application Code: _______________