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