Plymouth Community Food Pantry

Service Scholarship Form

Service Scholarship

Plymouth Community Food Pantry
Service Scholarship Application Form
DUE DATE: April 23, 2025

The Plymouth Community Food Pantry provides a one-time $1,200, merit and need based scholarship to a Terryville High School Senior who has shown exemplary work in community service and plans to continue their education, at a post-secondary institution with an intent to improve the future of mankind.

In addition to completing the Terryville High School Community Service requirement, each applicant must submit:

• a Terryville High School Transcript

• a Terryville High School Community Service Record

• confirmation of acceptance to a post-secondary institution

• two letters of recommendation, (preferably one from a THS staff member and the other from a person associated with either your community service or employment)

• a completed Plymouth Community Food Pantry Service Scholarship application (preferably submitted online at www.PlymouthFoodPantry.org )

• a Personal Essay

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

Name of Parent/Guardian 1(Required)

First Last

Name of Parent/Guardian 2

First Last

Number of Children(Required)

(18 or under) Living at Home (including yourself)

Annual Household Income Before Taxes(Required)

Name of Post-Secondary Institution Attending(Required)

Number of Years of Study Anticipated(Required)

Major/Area of Study(Required)

Tuition Cost(Required)

Room & Board Cost(Required)

Miscellaneous Expenses(Required)

Total Cost(Required)

List Your School and Community Extra Curricular Activities(Required)

List Your Special Interests and Hobbies(Required)

List Your Employment During Your High School Years(Required)

Upload your Terryville High School Transcript(Required)

Max. file size: 20 MB.

Upload your Terryville High School Community Service Record(Required)

Max. file size: 20 MB.

Upload your Confirmation of acceptance to a post-secondary institution(Required)

Max. file size: 20 MB.

Upload your Letters of Recommendation 1(Required)

Max. file size: 20 MB.

Upload your Letters of Recommendation 2(Required)

Max. file size: 20 MB.

Upload your Personal Essay(Required)

Max. file size: 20 MB.

Please write an essay describing how you developed an interest in community service, how you hope to grow during your post-secondary experience, and some of the aspirations and goals you would like to attain as you navigate throughout your life with the intent of helping mankind.

Student Signature(Required)

Parent/Guardian Signature(Required)

Donate

Every household pantry runs low at some time. The Plymouth Community Food Pantry is no different. You can help us by donating some of the items listed below. These items hardly ever change because we seldom receive them from our partner, Connecticut Foodshare. We usually purchase them. Your thoughtfulness is appreciated

Drop-Off Points

Plymouth Community Food Pantry

20 Dewey Ave., Terryville, Mon. & Wed. 1 hour before opening

Plymouth Volunteer Ambulance Corp.

191 Main St., Terryville, Rear Lobby

Adams Hometown Market

331 Main St. Terryville, basket by cash registers

Kids Cereal	Oatmeal	Canned Pasta & Ravioli
Canned Soup Chicken Noodle and Thick Soups	Baked Beans	Tuna
Spaghetti and Macaroni	Canned Fruit	Jelly
Coffee & Tea	Pancake Mix	Sryup
Baked Goods Cake Mix Brownie Mix Muffin Mix Flour & Sugar	Personal Care Shampoo, Deodorant, Bar Soap, Tooth Paste	Condiments Ketchup, Mayo, Mustard, Dressing
Nutritional Drinks Ensure/Boost Regular & Glucose Control	Gift Cards to Adams IGA

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Service Scholarship Form