the application form - Cornell Public Service Center

Cornell Public Service Center
ROBINSON-APPEL HUMANITARIAN AWARD
APPLICATION FORM
Name (last, first, middle initial) ________________________________________________
College ________________________ Major _______________________ Graduation Year _______
Local Address ____________________________________________________________________
City, State, Zip ____________________________________________________________________
Phone ______________________________________ Email _______________________________
Home Address ________________________________________________________________
City, State, Zip ____________________________________________________________________
Parents (optional) Father’s name (last, first, middle initial) __________________________________
Address ______________________________________________________________________________
City, State, Zip __________________________________________________________________________
Mother’s name (last, first, middle initial ) _______________________________________________________
Address (if different from above) _____________________________________________________________
City, State, Zip ____________________________________________________________________
Please attach separate sheets for the following.
I. PREVIOUS SERVICE OR HUMANITARIAN WORK
Please address, in no longer than a page, the service or humanitarian work that you have performed in the
last twelve months. Your description should include; (1) information about the people or programs you assisted
or the social problems you addressed, (2) the impact of these activities on others, and (3) how you were influenced by the work and the people with whom you worked.
II. PROPOSAL DESCRIPTION
Describe, in no longer than three pages, how you would use, for humanitarian purposes, an award of $1,500
and what effect your initiative would have within a community. Your proposal should include; (1) a statement
of goals including scope of project (ie. agencies and populations served, length of time providing service, etc).
(2) the steps you will take to achieve these goals, (3) the time you will give to the effort, (4) how and when you
will assess the results, and (5) a budget outline for the use of the funds (if you have an existing operational budget, how would this project budget fit in), (6) please address whether you will be starting a new human-service
organization or developing a project/program with an existing organization, and specify community partners.
III. ABSTRACT
Submit a brief paragraph summarizing your project.
If you are selected as a finalist, you will be contacted in advance to set a time for your prepared presentation
to the committee and follow-up questions, between 10:00 a.m. - 2:00 p.m. on April 17, 2015. The awards reception is on the same date. You must be available for an the presentation to be eligible for the award.
Please complete by typing or printing in ink. Attach additional sheets if needed. Please attach this cover sheet
to your letter of recommendation. Applications should then be scanned and emailed to Leslie Montanye at
lam79@cornell.edu. Complete electronic application and recommendations must be received by 4:00 p.m. on
March 20, 2015.
Cornell Public Service Center
ROBINSON-APPEL HUMANITARIAN AWARD
RECOMMENDATION FORM
STUDENT INFORMATION
Name (last, first, middle initial) ______________________________________________________________
College _____________________________________________ Major _____________________________
Local Address ___________________________________________________________________________
City, State, Zip __________________________________________________________________________
Phone ______________________________________
INFORMATION ABOUT PERSON PROVIDING RECOMMENDATION
Name (last, first, middle initial) _____________________________________________________________
Title _________________________________________________________________________________
College or community agency organization ___________________________________________________
Department (if applicable) _________________________________________________________________
Campus or Business address ______________________________________________________________
Campus or Business telephone ____________________________________________________________
Please attach this cover sheet to your letter of recommendation. Please include answers to the following questions:
How long have you known this student, and in what capacity? List your reasons for believing the student to be
a good candidate for this award, and describe the community service activities in which the student has been
involved. Comment on the contribution (s)he has made to the specific program or agency, or to the community
as a whole.
For further information about this award contact Leslie Montanye at the Public Service Center at 255.0144 or
Maja Anderson at 255-9382, or stop by the office at 200 Barnes Hall, Cornell University.
Guidelines
The Robinson-Appel Humanitarian Award recognizes and honors Cornell students for their outstanding humanitarian
efforts. In addition, the award provides support for students’ projects addressing a community’s social needs.
Awards of $1,500 each will be made to three students at Cornell for use in community-service activities as
directed by the recipients. A total of $4,500 will be distributed. The focus of an applicant’s efforts may be the
Cornell campus, the Ithaca community, or a location outside Tompkins County but within the United States and
its territories.
Students apply for the awards, and members of the wider community are invited to encourage students to
complete an application.
Application forms are available on the Public Service Center website at www.psc.cornell.edu. Completed applications,
including a letter of recommendation must be received by email March 20, 2015 in order to be disseminated to
the selection committee. Applications should be emailed to Leslie Montanye at lam79@cornell.edu.
Semifinalists must be available to attend a 20-minute prepared presentation of projects and follow-up
questions, between 10:00 a.m. - 2:00 p.m. on April 17th, as well as the awards dinner from 5:00 p.m. 8:00 p.m. that evening.
Business attire is recommended for your presentation and awards dinner.
If you have any presentation or audio-visual needs, arrangements must be made with Leslie Montanye at
lam79@cornell, at least one week prior to the presentation.
The Award will be granted on the basis of:
1. The student’s proposal to use the award money for an innovative approach to a social, governmental, or
legal problem within a community. This effort should demonstrate the student’s initiative and ability to translate
ideas into the practical result of meeting community needs. Projects should not be part of academic coursework, dissertation research, or for academic credit, but may be an outgrowth of previous work or course experience.
Proposals should include a timeline for completion, plans for evaluation, and a budget outline. All applications
must be accompanied by supporting documentation and/or a letter of recommendation from agency personnel
or a member of Cornell’s faculty or staff.
2. The student’s capability of carrying out the project. The committee needs an understanding of previous ability
of outstanding humanitarian service during the preceding twelve-month period. The service experience may be
in any field: for example, with on-campus organizations such as EARS, or Into the Streets; with local
organizations serving a particular clientele such as the disabled or elderly, people who are homeless, prisoners,
or at-risk youth; or with national efforts such as those that improve the environment, promote justice, or work
for conflict resolution.
If you have any questions about the application process, please contact the Cornell Public Service Center at
(607) 255-0144 or 255-9382 or stop by the PSC at 200 Barnes Hall.