Johnston Ziegler Safrit Scholarship Application 2026

We would like the opportunity to get to know you better. The information provided in this section will not be considered during the selection process and is intended solely to help us learn more about the applicant. Please list and briefly describe the extracurricular activities you have participated in during high school and your involvement in each. Please note years of involvement and any leadership roles.

Please list any honors and/or awards you have received during high school and the reason for receiving each honor or award.

The Johnston Ziegler Safrit Youth Leadership Scholarship is built on the pillars of leadership, advocacy, and service, which were exemplified by our organization’s leaders Dr. John Johnston, Barbara Ziegler, and Libby Safrit. The purpose of the scholarship is to recognize teens who are changemakers and who impact their communities through these pillars. The questions below will give you a chance to show us the ways that you have impacted your community through leadership, advocacy, and service. Use these questions to show us why your community achievements should be recognized through the Johnston Ziegler Safrit Youth Leadership Scholarship. Describe the contributions to your community that you are most proud of. This could be in school, your neighborhood or rec center, your faith community, your friend group or family, your sports team or after-school club, an organization you volunteer for, or any other setting where you demonstrated leadership, service, and advocacy. What was the community problem or issue you addressed? What action(s) did you take to address the issue? How did you demonstrate leadership, service, and advocacy? What impact did you make? What have you and others gained through those experiences? (1,000–1,500 words)

Please make sure the following information is included in each letter of recommendation. Who is submitting your letters of recommendation: (final writers may change but this information will assist our team with information tracking) The recommender's name. The applicant's name. The recommender's relationship to the applicant.

I hereby grant Teen Health Connection permission to use, re-use, exhibit, distribute, or publish my and/or my child’s testimonials, images, artwork, portraits, pictures or videos for any Teen Health Connection purpose including but not limited to Teen Health Connection illustrations, art, videos, promotional materials, editorials, advertising, publications, websites or web content, all without any compensation. I understand that any images, videos, or artwork may be used at exhibits and may identify me and/or my minor child. I relinquish any right that I may have to inspect, examine, or approve any completed product or products or any written or electronic copy or other printed materials that may be used in conjunction with any of the foregoing. I understand and agree that all materials containing the images or artwork of me and/or of my minor child shall become the property of Teen Health Connection. I hereby release, discharge and agree to forever hold harmless Teen Health Connection, its legal representatives or assigns, and all persons or entities functioning under its permission or authority from all and any claims, demands or causes of action ensuing from or in connection with the use or publication of any of the foregoing including without limitation any claims for libel or invasion of privacy. This authorization and release shall inure to the benefit of the legal representatives, licensees, and assigns of Teen Health Connection and shall be binding upon me and upon my estate, my heirs, and my legal representatives. I have read and fully understand the content, meaning, and impact of the foregoing and represent that I am the individual named below. I agree that I am over the age of majority or that I am the parent or legal guardian of the minor child named below, am over the age of majority, and hereby consent to the foregoing on behalf of such minor child named below.

By submitting this application I certify that I:

• Am a senior in high school who is in good standing and on track to graduate by the Spring of 2027.
• Intend to attend a college or university in the fall of 2027.
• Am available for pictures, videos, and other promotional activities associated with the award.
• Acknowledge it is my responsibility to complete all parts of this application and to ensure the writers of my letters of recommendation submit their letters by the deadline.