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Capital District Chapter of the New York
Water Environment Association
For application form: Print the above text panes or contact Vince Cordi

           NEW YORK WATER ENVIRONMENT ASSOCIATION
    CAPITAL CHAPTER R. PAUL FARRELL, JR. SCHOLARSHIP

    INTRODUCTION – The New York Water Environment Association, Inc. (NYWEA), was founded in 1929 by
    professionals in the field of water quality as a non-profit, educational organization.  The NYWEA consists of
    seven local chapters representing the various geographic regions across the State: the Capital, Central,
    Genesee, Long Island, Lower Hudson, Metropolitan, and Western.  The Capital Chapter covers Columbia,
    Greene, Schoharie, Albany, Rensselaer, Montgomery, Schenectady, Fulton, Saratoga, Washington,
    Hamilton, Warren, Essex, St. Lawrence, Franklin and Clinton counties.

    THE AWARD – The Capital Chapter of NYWEA is offering two awards of $1,000.00 to be paid directly to the
    student.  The student must be enrolled in an environmental related curriculum at the undergraduate level
    (such as, but not limited to, biology, forestry, chemistry, engineering, and water/wastewater treatment).  
    Awards will be distributed on academic, extracurricular and community activities, references, and personal
    goals.  The award will be presented at the Capital Chapter’s Spring function.  Disbursement of funds will be
    in the Fall following submission of proof of enrollment.  As an added benefit, the successful student will be
    automatically enrolled in the New York Water Environment Association as a student member for a period of
    one-year following award of the scholarship.

    ELIGIBILITY  - Applicants must be enrolled as a high school senior at the time of application.  The student
    must reside in the geographic area that the Capital Chapter encompasses.

    APPLICATION – Eligible students must complete this application.  Each student may fill out only one
    application. If any of the application is incomplete or not included, the application will not be considered.  
    The signed application must be submitted together with:

    1.        An official high school transcript:

    2.        A minimum of two written references: One must be from a teacher.
             The other must be from someone not related to the applicant.

    3.        Return the completed application along with the necessary attachments to:

                                                                                       Richard J. Lyons
                                                                                       Albany County Sewer District
                                                                                       NYWEA Capital Chapter
                                                                                       P. O. Box 4187
                                                                                       Albany, NY 12204
                                                                                       518-447-1617


    SELECTION – Applications that are received by the application deadline will be distributed to the Scholarship
    Committee for consideration.  The Committee will then make their recommendation to the Capital Chapter’s
    Executive Board for approval.  Judging will be based on essays, academic performance, extracurricular and
    community activities, references and personal goals.  The Executive Board may request to conduct brief
    interviews with potential candidates to aid in the selection process.

    APPLICATION DEADLINE: April 1st, 2011
                           SCHOLARSHIP APPLICANT INFORMATION



    Applicant will not be considered unless all information is completed in full and all requested
    documentation is provided. Please type or print clearly and answer all questions completely.





    Name ____________________________________________ Email _____________________________


    Street address _______________________________________________________________________


    City________________________________State ___________  Zip Code ________________________


    Telephone Number (      ) _______________ Social Security # ________________________________




    Name of Institution you plan to attend: ___________________________________________________

    _____________________________________________________________________________________



    Honors and Awards: ___________________________________________________________________

    _____________________________________________________________________________________

    _____________________________________________________________________________________



    Curricular, extracurricular and community service activities, and employment (include # hrs/wk)
    _____________________________________________________________________________________

    _____________________________________________________________________________________

    _____________________________________________________________________________________



    Career and Education: _________________________________________________________________

    _____________________________________________________________________________________

    _____________________________________________________________________________________
    Essay Information


    Please complete responses to each of the following questions. It will be necessary to use a separate
    sheet of paper, since your responses should be 200 - 300 words. Please type your responses. Points will
    be deducted if responses are not typed.



    1)    What do you see as the most important scientific, technological or global development of
          your lifetime? How has it shaped your life or goals?




    2)    What is the most pressing environmental problem facing youth today?





    3)    Besides your parents, what person has been most influential in your life and why?





                                           CERTIFICATION AND RELEASE AUTHORIZATION
                                     I certify this information is true, complete and accurate.
         I also authorize the release of this information to confirm and or verify this application.
                                                 APPLICATION DEADLINE  April 1, 2011




    Student's Signature ______________________________________________ Date ________________




    Parent's/Guardian Signature________________________________________ Date ______________