AAA-The Auto Club Group-MichiganPublic Affairs Department
313-336-0974 [email protected]
Student CertificationI certify that the application submitted
meets with the rules and conditions of the AAA School Safety Patrol
Scholarship in Michigan. I agree by signing below that I have
abided by the rules and give consent for my name, likeness, and/or
photograph to be used without compensation in all promotional
materials concerning this scholarship. I understand that the
decision of the scholarship committee is final in all respects. I
hereby acknowledge that all materials submitted will become the
property of AAA–The Auto Club Group.
Student Information
This form may be photocopied.
AAA School Safety Patrol Scholarship Application
18-T
F-0020
Name: ________________________________________
School: ________________________________________
Birth Date: _____________________________________
Phone: ________________________________________
Home Address: __________________________________
City: __________________________________________
State: _____________________ Zip: _______________
Email: _________________________________________
Signatures
Student: _______________________________________
Parent/Legal Guardian: ____________________________
Date: _________________________________________
AAA School Safety Patrol® Michigan
Scholarship Application
Guidelines• Applications must be postmarked on or before
• Applications are limited to one per school.• Applications are
the property of AAA–The
Auto Club Group and will not be returned.• By submitting the
scholarship application,
participants expressly agree to the rules andthe decisions of
the Committee.
• The scholarship recipients are the only studentswho will
receive a notification letter. The letterwill be sent no later
than
• Scholarships will be awarded in the name of thestudent and the
institution of higher learning.
• Scholarship recipients must provide proof ofacceptance to an
accredited institution ofhigher learning.
• Scholarships are not transferable or redeem- able for cash at
any time.
• Scholarship must be claimed by
• Recipient should check with a tax advisor re- garding the
possible tax implications of this gift.
Selection Procedure• The AAA School Safety Patrol
Scholarship
Committee in Michigan will determine thewinning recipients.
• AAA–The Auto Club Group reserves the rightto modify or
terminate the AAA School SafetyPatrol Scholarship Program at any
time.
• Children and family members of AAA–TheAuto Club Group
employees, officers andboard members are not eligible
(includinggrandchildren, nieces, nephews etc.).
p A personal letter of introduction describing community
involvement, extra-curricular activities and what being part of the
AAA School Safety Patrol program has meant to you.
p A letter of recommendation from a school official AND a letter
of recommendation from a community representative. Ex: teacher,
counselor, principal, youth leader, employer or other.
p A copy of junior year transcript documenting a minimum 3.0
GPA.
p A copy of exam results of ACT with a minimum score of 21 or
SAT with a minimum of 950.
p Proof of AAA School Safety Patrol participation in Michigan,
verifying service in good standing; such as a letter from an
elementary school principal, copy of AAA School Safety Patrol
certificate, etc.
p Signature of parent/legal guardian and school counselor.
Two $2,500 scholarships will be awarded to graduating seniors
who served as AAA School Safety Patrol® members in Michigan.
Students must submit documentation of AAA School Safety Patrol
participation, good academic standing and a strong record of
participation in the community and extra-curricular activities.
RequirementsAll applicants must be a graduating high school
senior from a public or parochial high school or private
preparatory school within AAA – The Auto Club Group service area in
Michigan. This includes reasonable and non-discriminatory rules and
regulations as developed by the Committee and accepted by an
institution of higher learning.
DocumentationAll applications must provide:
AAA School Safety Patrol Scholarship Application(Continued from
other side)
Please provide the following information along with the
documents listed in the Documentation section of this form.
AAA School Safety Patrol School:
____________________________________________ School Year
Served:
____________________________________________ Name of
college/institute applicant plans to attend:
____________________________________________ Planned field of
study:
____________________________________________ Signature of
current principal/counselor:
____________________________________________ Printed name of
current principal/counselor:
____________________________________________
Date: ________________________________________
Please return this application to your school’s
Counseling/Guidance Office no later than DO NOT send this to AAA.
The school will be responsible for submitting their selected
nominee application by
____________________________________________
For Counseling/Guidance Office use only: Send submissions
to:
[email protected]
Questions/comments: [email protected]
p Sign, date and attach the Publicity Release to the
application.
Date: Date 2: March 19, 2021.Name: School Name: Birth Date:
Contact Phone Number: Home Address: City: State: Zip Code: Email
address: Validation Date of Application: 2020-2021Notification
Date: April 16, 2021Claim Date: July 31, 2021Check Personal Letter:
OffCheck Recommendation: OffCheck Transcript: OffCheck Score:
OffCheck AAA SSP participation: OffCheck Signatures: OffSSP School
Name: School Year Served: Attendee Name: Planned Field of Study:
Name of counselor: Date signed: Due date to counselor: March 20,
2020.Submission deadline: March 19, 2021Validation Date of
application: 2020-2021Publicity Release: Off
