Scholarship Form - Rotary Club of San Carlos

Date(Required)

High School(Required)

Scholarships are awarded on annually based on financial need, community service, and academic performance. In order for the Scholarship Committee to consider each applicant fully, it will be necessary for the following questions to be filled out in a complete and accurate manner. All information will be handled in a confidential manner.

First Name(Required)

Middle Name

Last Name(Required)

Phone(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Marital Status(Required)

Single

Married

Age(Required)

Father's Name and Address(Required)

Mother's Name and Address(Required)

Father's Occupation(Required)

Mother's Occupation(Required)

Annual Salary(Required)

(OR GUARDIAN) We reserve the right to confirm this data based on IRS tax returns.

Number of dependents in family: Brothers(Required)

Please enter a number greater than or equal to 0.

Number of dependents in family: Sisters(Required)

Please enter a number greater than or equal to 0.

Where will you live while at college?(Required)

Check the following items which you, as a college student, must provide:

Room and Board(Required)

All

Partial

None

Books(Required)

All

Partial

None

Clothing(Required)

All

Partial

None

Tuition(Required)

All

Partial

None

Dollar Amount(Required)

Transportation(Required)

All

Partial

None

Dollar Amount(Required)

State the approximate amount (total cost) that you anticipate you will have to pay for your first year in college.(Required)

How much will you be able to pay?(Required)

What are your vocational or long term goals?(Required)

What are your educational goals?(Required)

List in order of preference the colleges or universities to which you plan to apply for admission, or have been accepted.

What is your grade point average?(Required)

Have you worked during your school experience? List type of employment:

What would receiving a scholarship mean to you? (discuss financial arrangements, unusual expenses, special family needs, etc.)

Other scholarships received or applied for:

Activities Record

School offices held (Student body, class, other) + Year Held

Please add what grade you held these offices (ie "Class President (12)" )

School club activities (Membership, offices held) + Year Held

Please add what grade you participated (ie "Drama Club (9, 12)" )

Other school activities (Athletics, drama, speaking) + Year Held

Please add what grade you participated (ie "Debate Club (12)" )

Outside Activities

Organizations: (Offices in churches, clubs, scouts, Red Cross, etc.) + Year that you participated

Please add what grade you participated (ie "Girl Scout (9, 10, 11, 12)" )

Honors and awards won + Year you won the award

Please add what grade you won these honors (ie "Girl Scout Silver Award (11)" )

Individual activities, hobbies

Please add what grade you participated (ie "Girl Scout (9, 10, 11, 12)" )

Are you ready to submit your application?(Required)

Yes

Not Yet