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Hi there, please fill out and submit this form by May 10, 2026.
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1
Student's Full Name
*
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First Name
Last Name
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2
Current Grade
*
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Elementary (K-5)
Middle School (6-8)
High School (9-12)
Other
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Please Select
Elementary (K-5)
Middle School (6-8)
High School (9-12)
Other
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3
School Name
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4
Age (optional)
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5
Your Full Name
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First Name
Last Name
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6
Your Relationship to Student
*
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Parent/Guardian
Youth (self)
Family Member
Teacher
Coach
Youth Leader
Other
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7
Your Email Address
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example@example.com
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8
Your Phone Number (optional)
Area Code
Phone Number
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9
Types of Academic Recognition
*
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Honor Roll
Academic Awards
Special Programs (e.g., Gifted, STEM, AP)
Improvement in Grades
Other
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10
Describe the student’s academic accomplishments or growth.
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11
Commitment to learning / academic effort (1 = Needs Improvement, 5 = Excellent)
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2
3
4
5
1
5
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12
Leadership Roles Held
*
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Team Captain
Club Officer
Student Council
Peer Mentor
Volunteer Leader
Church/Youth Group Leader
Other
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13
Describe how this student demonstrates leadership.
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14
Leadership and initiative (1 = Needs Improvement, 5 = Excellent)
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1
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3
4
5
1
5
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15
Character Traits Demonstrated
*
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Respectful
Responsible
Compassionate
Honest
Hardworking
Servant-hearted
Other
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16
Share a specific example that shows this student’s character.
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17
Overall character and example to others (1 = Needs Improvement, 5 = Excellent)
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5
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5
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18
How have you seen this student grow in their faith?
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19
In what ways does this student live out their faith at home, school, church, or in the community?
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20
Engagement in faith and spiritual growth (1 = Early in Journey, 5 = Growing Strong; for encouragement only)
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3
4
5
1
5
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21
Upload Youth Photo (optional if photo will be taken at church). Only one image file, suitable for print.
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22
I give permission for this student’s name, photo, and accomplishments to be shared in church communications and recognition events.
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I agree
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23
By submitting this form, you affirm that the information provided is accurate to the best of your knowledge.
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24
Image Field
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