Applicants: I agree to the rules of the ACLU of WV Foundation scholarship process. I affirm that the information enclosed in the application is accurate and original to me, and I authorize the ACLU of WV Foundation to reproduce, distribute, create derivative works of and publicly display my essay in all media now known or hereafter developed in connection with its mission, including for promotional purposes. If I am a recipient of an ACLU of WV Foundation Youth Activist Scholarship, I grant the ACLU of WV Foundation the right to use my name, likeness, and biographical information in all media in connection with ACLU of WV Foundation's mission, including promotional materials without any further compensation or permission.
For applicants under 18: Consent from a Parent or Legal Guardian is also required I, ______________________, represent that I am the [parent/guardian] of the above named individual. I have read the foregoing and fully understand the contents hereof. I hereby consent to the foregoing on his/her behalf.
Signature: ________________________________ Date: ___________________
On separate pages, please attach a personal statement of 1,000 words or less describing your civil liberties activism. Please include your understanding of what it means to be a civil liberties activist, specific examples of how you demonstrated your dedication to civil liberties, challenges you overcame, and how you showed leadership.
Please select a teacher, counselor, or individual associated with an organization you are involved with to serve as your reference and have him/her complete this section. (Please do not use a family member.)
In what capacity and how long have you known the applicant?
How has the applicant shown his/her commitment and activism to civil liberties? Please provide specific examples.
How has the applicant shown leadership and teamwork in his/her community, both through his/her activism and otherwise. Please provide specific examples.
How do you see the applicant continuing his/her civil liberties activism in college?