Parents, Families, and Friends of Lesbians and Gays (PFLAG) – Detroit

Scholarship Program Nomination Form 2010

 

PFLAG-Detroit is pleased to provide one $500 college scholarship to a student who has shown support for gay, lesbian, bisexual, or transgender individuals or programs.  Applicants need to demonstrate the advanced measures taken to promote positive images for the GLBT community.  Nominations must be submitted by May 30th of each year and awards will be made by second Sunday of August annually.  Applicant’s home address MUST be in Wayne, Oakland, or Macomb Counties.  The award will be made out to the educational institution and the awardees' name. 

 Please mail completed nomination to: PFLAG-Detroit, P.O. Box 1169, Royal Oak, MI 48068-1169

 

When making these awards PFLAG-Detroit will not discriminate against any individual based upon race, color, religion, sex, national origin, age, sexual orientation, disability, or disabled veteran, Vietnam era veteran, or other eligible veteran status.

Individual preparing this nomination:           

Individual nominated (You may nominate yourself for this award):
Name:_________________________________________________

Address _______________________________________________

City __________________________   St  ____  Zip ____________

Phone ____________________________________                              

Email Address ________________________________________

 

Name _______________________________________________

City ________________________   St  ____  Zip ____________

Phone __________________________________                              

Email Address ________________________________________

County of Residence _____________________________

Name of Current School __________________________

Graduation Date ___________________

Planned College  ___________________________

 Start Date __________________________

 

 

 

   Please describe  how this individual has shown support for gay, lesbian, bisexual, or transgender individuals or programs: