2018 National Civil Rights Museum Student Forum Keeper of the Dream Application Form

This application is to be completed by hardworking and dedicated young individuals or groups who have demonstrated a commitment to ensuring equal rights and opportunities for others and a commitment to service in their communities.

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* 1. Name:

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* 2. If you are entering on behalf of a group, please provide the other group members names and email Dynisha Woods at Dynisha.Woods@ipaper.com to provide details on group members for nomination.

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* 3. Date of Birth (MM, DD, YYYY):

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* 4. School currently enrolled:

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* 5. Grade:

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* 6. Email:

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* 7. Home Mailing Address (Street Address, City, State):

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* 8. Phone:

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* 9. Parent or Guardian's name:

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* 10. Parent/Guardian's Phone:

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* 11. Parent/Guardian's Email:

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* 12. List approximate number of volunteer hours served.

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* 13. List the organizations involved with and contact names if available.

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* 14. I certify that my recommendations are not from a relative nor an employee at International Paper.

I certify that my recommendations are not from a relative nor an employee at International Paper.

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* 15. Please provide the name, email, and phone number of the agency or organization you serve or volunteer that is providing the recommendation letter.

Name

Email Address

Phone Number

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* 16. Please upload the recommendation letter

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.

Choose File

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* 17. Please provide the name, email, and phone number of your educational reference that is providing the recommendation letter.

Name

Email Address

Phone Number

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* 18. Please upload the recommendation letter

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.

Choose File