Lions Young Ambassadors of the

21^st Century Award Program

Please Note: Contact information for local school districts can be obtained at

http://edna.ed.state.pa.us

How to Apply

1. Read the information in this application

2. Contact the Lions club’s Young Ambassadors award chairman to learn about

requirements and selection process.

3. If you meet all eligibility criteria, complete this form, providing all of the

information requested. Additional pages may be attached as needed.

Submit the signed application form to the Lions club award chairman named below.

Lions Club Deadline March 5, 2010

____________________________________

LIONS CLUB YOUNG AMBASSADORS AWARD CHAIRMAN

___________________________________

LIONS CLUB NAME

________________________________

ADDRESS

_________________ ____________________

TELEPHONE EMAIL

Youth Candidate Award

Application

The Lions Young Ambassadors of the

21^st Century Award recognizes young

people for their outstanding community

service involvement, leadership

accomplishments, public speaking skills

and scholastic achievement. The awards

encourage young people to seek

experience in these areas and recognize

the value of their achievements.

Eligibility

The Young Ambassadors of the 21^st

Century Award district competition

is for young people in grades 9-12,

whose candidacy is sponsored by a

Lions club. Contact your Lions club

for information on its candidate

selection process.

Award Process

Each Lions club may sponsor one

candidate to the District 14M

Young Ambassadors of the 21^st

Century Award competition. The Award Recognition Award Criteria

club’s Young Ambassadors award

chairman and candidate work The young person selected as the Young Ambassadors of the 21st

together to complete and submit the winner of the District 14M Young Century Award candidates at the

final Youth Candidate Application. Ambassador of the 21^st century district level are evaluated on

will be presented with $500, the basis of their:

Lions Club candidates and a the second place winner will

distinguished panel of judges will receive $250 and the third place * community service involvement (25%)

come together for the district-level winner $100. * leadership accomplishments (25%)

judging event. At this time, each All candidates will receive a * scholastic achievement (5%)

candidate participates in an certificate of recognition. * interview performance (20%)

interview with the judging panel and * public speaking presentation (25%)

presents a five-minute speech to the

judges and an audience.

Lions District Application Deadline March 19, 2010

Date & Location for Judging April 25, 2010

Location to be determined at a later date

Lions Young Ambassadors of the 21^st Century Award Program

Application Form

Candidate Information

First Name_________________________ Last Name_______________________________

Street Address_________________________________________________________________

City___________________________ State___________ Postal Code____________________

Telephone_________________________ email address________________________________

Age_______________________________ Male Female

Agreement

We certify that all information contained in this application is true and factual. We also agree that if the

applicant is selected as a candidate for the Young Ambassadors of the 21st Century Award, he or she will

attend and participate in the District 14M judging event on April 25, 2010.

Applicant’s Signature____________________________________________

In addition to the above agreement, I hereby consent to my son/daughter participating in the Young

Ambassadors of the 21^st Century Award and related activities.

Parent/Guardian Signature_________________________________________ Date___________________

Attention: Applications must be in the hands of a member of a local Lions Club by March 5, 2010.

Individual clubs must choose a winner from the applications received and have them to

a cabinet member or chairperson of a Youth Committee by March 19, 2010.

Please answer all questions on a separate sheet of paper

Community Service (25 points)

List specific community service activities, projects and events in which you have been involved during the

past three (3) years.

Activity/Project/Event People/Institution that benefited from service Estimated hours of service

In the past three years, how many total hours did you spend on community service activities, projects and

events? Estimated number of hours?

Describe how you demonstrated leadership skills and showed initiative for two to three major community

service activities, projects or events during the past three (3) years.

What specific results were achieved through your community service? (i.e., number of people served, goals

reached, services created, funds raised, etc.)

Explain what you have learned and how you have benefited by being involved in community service.

Check if appropriate; I have received the Lions Young Leaders in Service Award

Silver Award (for 50 hours of community service) Gold Award (for 100 hours of community service)

________________________________________

Leadership Accomplishments (25 points)

List the leadership roles you have filled in the past three years.

Dates Leadership role Organization/group

Explain what your leadership has accomplished for yourself and for the organization/group you helped lead.

____________________________________________________________

Scholastic Achievement (5 points)

Please attach a copy of a school transcript that reflects courses completed and grades achieved over the

past three (3) years. List any honors, awards or scholarships you have received as a result of your

scholastic achievement.

Date Honor, Award or Scholarship Honor/Award/Scholarship Criteria

________________________________________

Interview (20 points)

Each finalist in the Lions Young Ambassador of the 21^st Century Award contest will participate in an

interview with a panel of judges. This interview will be evaluated on the basis of:

· content of responses to questions

· verbal presentation style (volume, grammar, pronunciation)

· nonverbal presentation style (gestures, grooming, eye contact)

________________________________________

Public Speaking (25 points)

Each finalist will present a five minute speech to a panel of judges and a small audience. The candidate’s

public speaking ability will be evaluated on the basis of:

· content of speech

· presentation style (verbal and nonverbal)

· visual aids (visibility, effectiveness, appropriateness)

Each finalist will receive the topic for his/her speech after the first level of judging has been completed.

Thank you for your participation in the Lions Young Ambassadors of the 21^st Century Award contest.

If there are questions concerning your eligibility, sponsorship by a Lions Club, or any concerns you

may have, please contact me at:

Dottie Hill, Young Ambassador Chairperson

319 N. Main St .

Houston , PA 15342

724-745-9595

email dottie2001@verizon.net