SCHOLARSHIP APPLICATION FORM

SUBMIT BETWEEN MONDAY, APRIL 25 AND SATURDAY, APRIL 30, 2011

Name:

High School:

Your Street Address:

Your Mailing Address:

Telephone:

E-mail Address:

I am a child or grandchild of a Rotary Club member Yes/No:

 Yes  No

Class Rank:

Overall High School GPA:

Last Semester GPA:

ACT Composite (highest):

ACT Percentile:

Parent (or Guardian) Name(s):

Fathers Occupation & Employer:

Mothers Occupation & Employer:

List siblings who are attending college and where:

EDUCATIONAL PLANS

To which colleges or universities have you applied?:

At which colleges or universities have you been accepted?:

Which college or university will you attend?:

What is your college major?(if you are uncertain, what subjects most interest you?):

FINANCIAL INFORMATION

Can you attend college without a scholarship?:

Will you need part-time employment in addition to this scholarship?:

What other scholarship aid or prizes have you applied for (list amounts)?:

What other scholarship aid or prizes have you won so far (list amounts)?:

How much is the annual tuition (including room and board) at the college you plan to attend?:

How much can you and your family contribute to your college expenses per year
(this amount should be consistent with what was figured on your FAFSA application)?:

Are you presently employed?:

If yes, List place of employment:

ACTIVITIES AND HONORS

Provide highlights here, and detail in your resume:

Academic honors received while in high school:

Offices held in high school and other activities, including community service, if any:

Submit Button When Finished: