Application Form
This form must be completed personally by the applicant - please note ALL fields must be filled out
  1. Complete the fields below as indicated
  2. Press Preview Form to see what your form looks like before printing
  3. If you are not happy with how the printable page looks, or want to change anything, you can press the Modify Text Entered button to return here and make any changes
  4. If you are happy with how the printable form looks, press Print

    5. After printing, remember...
  5. You must sign and date the form yourself
  6. You must get your Parents or Guardians to sign and date the form
  7. You must get a Teacher to supply a reference
  8. You may also provide the contact information of a referee from your volunteering organisation or activity
  9. You must get your School Principal to sign, certify and submit the form to Pramerica on your behalf
Applicant Information
Your Personal Details
Last Name: First Name: Middle Initial:
Street/Townland: Town: County:
Male:       Female:   Date of Birth:   
Your Phone number: Email Address:
Your school details
School Name: Town: County:
Select the school year you are in for 2010/2011:
Republic of Ireland  
1 2 3 4 5 6
Northern Ireland     
8 9 10 11 12 13 14 		Award Category:
    Junior under 16 years
   Senior under 19 years
Your Parents/Guardians Details:
Name:  Phone: 
Activity Summary
Briefly answer the following questions within the space provided (no additional sheets), then provide more detail in the sections below.
What was your volunteer community activity?   
Approximately how may hours per week did you spend on the activity?         No. of weeks?   
When did you start working on the activity (month/year)?   
Is the activity still ongoing?                             
If not ongoing, when did it end (month/year)?                    

Motivation
Briefly explain what motivated you to carry out your voluntary community activity

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Service
Briefly explain what your voluntary community activity involved

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Impact
How did your activity impact on the community and other people?

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Sustainability
What do you envisage will be the lasting impact of your volunteering activity?
Have you a long-term commitment to volunteering (either with your current activity or other community volunteering)?
Outline the details

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Commitment
Describe in the space provided what your voluntary community activity involved in terms of personal commitment (you may refer to the time involved or personal involvement, or both)

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Personal Challenge
Describe the level of personal challenge that the volunteer activity required, including the degree of challenge that you faced, problems or obstacles that arose and, in particular, how you overcame these. What support structures (if any) were in place?

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Print and Submit
Once you have completed the information above, please press Preview Form. After printing, sign the form yourself, have your parents or guardian sign it also, and then take it to a Teacher to supply a reference. You may also supply the contact information of a referee from your volunteering organisation or activity. Finally, forward your application to your School Principal for the required certification. Your Principal will review your application and submit to Pramerica on your behalf.
 


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