TO: FROM: SUBJECT: DATE:

High School Principals and College Advisors The Fund for Public Schools Arlene Dominguez The Janine Brawer Gift of Life Scholarship Application February 13, 2013

Application Deadline: March 22, 2013 The Fund for Public Schools and the Janine Brawer Scholarship Foundation are pleased to invite applications for the Janine Brawer Gift of Life Scholarship, which will award college scholarships to outstanding public high school seniors. It was created in honor of Janine Brawer, who was a high school senior when she was struck by a car outside Tottenville High School in November 2009. Janine was a talented writer who truly cared about others. Although just 17 years old, Janine had expressed the desire to be an organ donor because she was aware of its life saving potential. Tragically, the Brawer family fulfilled Janines wish when she died six days after her accident, never having regained consciousness. To keep her spirit and memory alive, the Brawer family began the Gift of Life Scholarship in 2009 to make high school students and their families aware of the importance of becoming an organ donor. Every year since then, the Brawer family has awarded one Tottenville High School senior a college scholarship. If you are a Tottenville High School senior, please visit your College Office for that separate application. This year, to increase awareness of the need for organ and tissue donors, the Brawer family will be providing an additional scholarship open to all high school seniors attending New York City public schools. For more information on the Janine Brawer Scholarship Foundation visit: http://jbsf.weebly.com/thefoundation.html. For more information on organ donation visit: www.donatelifeny.org The Janine Brawer Gift of Life Scholarship will select promising New York City high school seniors who have created a piece persuading others to become organ donors. One winner will receive a $5,000 scholarship and four runner-ups will each receive a $2,500 scholarship. The scholarship money will be distributed to the winners upon proof of enrollment at a postsecondary institution. Winners will be invited to attend an award reception with Chancellor Dennis Walcott and Helen Irving, CEO of the New York Organ Donor Network the week of April 19, 2013. Selection Criteria Seniors at public high schools throughout New York City are eligible to apply. Specific qualifying criteria include: 1. Excellent persuasiveness and strong grasp of the importance of organ donation, as demonstrated by a submission of a creative piece which responds to the following: Why become an organ donor? This piece can be in the form of an essay, a song, a poster, a video or any other form of media.

Please use the attached cover sheet and mail the original completed application including required attachments for each candidate to:

ARLENE DOMINGUEZ NEW YORK CITY DEPARTMENT OF EDUCATION THE FUND FOR PUBLIC SCHOOLS 52 CHAMBERS STREET RM. 305 NEW YORK, NY 10007 Deadline: March 22, 2013 INCOMPLETE APPLICATIONS WILL BE DISQUALIFIED.
Only finalists will be notified by the Selection Committee. Finalist interviews will be scheduled for early April. Winners will be notified of their awards by letter and telephone by April 12, 2013.
The Fund for Public Schools The Fund for Public Schools is dedicated to improving New York City's public schools by attracting private investment in school reform and encouraging greater involvement by all New Yorkers in the education of our children. The Fund plays a pivotal role in improving public education in New York City by strengthening the New York City Department of Educations relationship with the private sector, securing funding for critical education reform initiatives, helping businesses to create partnerships and programs that support city schools, and raising public awareness about the public schools. The Fund is a 501(c)(3) nonprofit organization. For more information about The Fund for Public Schools, visit www.fundforpublicschools.org The Janine Brawer Scholarship Foundation In a desire to further Janines legacy, we provide college scholarships to Tottenville High School seniors in Staten Island, New York, who produce material persuading others to consider what Janine courageously chose -- organ donation. It is our hope that the work produced for this scholarship will be instrumental in convincing others to sign up to become organ donors. We know that Janine lives on in others who received her gifts of life. The many others who have chosen to follow Janines example demonstrates that as young as she was, she made a tremendous difference in this world. For mor information about the Janine Brawer Scholarship Foundation, visit http://jbsf.weebly.com/thefoundation.html

The Janine Brawer Gift of Life Scholarship Application

Student should fill out this form and submit to the School Guidance Counselor for completion. Deadline for receipt by The Fund for Public Schools is Close of Business March 22, 2013.
TO BE COMPLETED BY STUDENT Please print legibly. High School: _____________________________________________________ District #_______________ High School Address: _______________________________________________________________________ Students Name: First _________________________________Last___________________________________ Male/Female (optional): __________________ Race/Ethnicity (optional):___________________________ Students Street Address: ____________________________________________________________________ City: ______________________________________________ State: _____________ Home Telephone: ( ) _______---______________ Cell Phone ( Zip Code:_________

) _______---______________

E-mail Address:____________________________________________________________________________ Students Social Security Number (Optional): _______________--- _______________---________________ TO BE COMPLETED BY GUIDANCE COUNSELOR AND/OR PRINCIPAL Guidance Counselor Name: ______________________ Contact Number: ( ) _______ - ______________ E-mail: ___________________________

Endorsement: I believe this student is a good candidate for the Janine Brawer Gift of Life Scholarship and recommend him/her for consideration. Name (print) _____________________________________________________________________ Signature: ________________________________________________ (original signature required) CHECK LIST: PLEASE ATTACH TO THIS APPLICATION THE FOLLOWING Applicant: Persuasive piece in response to the question: Why become an organ donor? Signed consent form to photograph, film or videotape.

Please direct any questions you may have about this application to: Arlene Dominguez New York City Department of Education The Fund for Public Schools 52 Chambers Street RM. 305 New York, NY 10007 Phone: 212-374-6823 E-mail: ADominguez2@schools.nyc.gov

CONSENT TO PHOTOGRAPH, FILM OR VIDEOTAPE A STUDENT FOR NON-PROFIT USE (e.g.: educational, public service or health awareness purposes) Name of Student: ____________________________________________________________________________ School: _______________________________________________________________ Class: _______________ I, _________________________________________, hereby consent to the participation in interviews, the use of (Print Parent or Guardians Name) quotes, and the taking of photographs, movies or video tapes of my son/daughter and his/her school-related work by The Fund for Public Schools and the Janine Brawer Scholarship Foundation. I also grant to The Fund for Public Schools and the Janine Brawer Scholarship Foundation, the right to edit, use and reuse said products for non-profit purposes. I also hereby release The Fund for Public Schools and the Janine Brawer Scholarship Foundation and its agents and employees from all claims, demands, and liabilities whatsoever in connection with the above.

The Janine Brawer Gift of Life Scholarship Application

_________________________________________________________ (Signature of Parent/Guardian)

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__________________________________________________________________________________________ (Address of Parent/Guardian)