Scholarship Form - Rotary Club of San Carlos

Date

High School

Scholarships are awarded on annually based on community service, academic performance and financial need. 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

Middle Name

Last Name

Marital Status

Single

Married

Age

House Number

Street

City

State

Zip Code

Phone Number

Email Address

Father's Name and Address

Mother's Name and Address

Father's Occupation

Annual Salary

Mother's Occupation

Annual Salary

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

Number of dependents in family: Brothers

Number of dependents in family: Sisters

Where will you live while at college?

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

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

How much will you be able to pay ?

What are your vocational or long term goals?

What are your educational goals?

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?

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

Explain why you need scholarship help (discuss financial arrangements, unusual expenses, special family needs, etc.)

Other scholarships received or applied for:

Activities Record

School offices held (Student body, class, other)

What grades did you hold school office?

(eg 9, 10, 11, 12)

School offices held (Student body, class, other)

What grades did you hold school office? (2)

(eg 9, 10, 11, 12)

School offices held (Student body, class, other)

What grades did you hold school office? (3)

(eg 9, 10, 11, 12)

School club activities (Membership, offices held)

What grades did you participate in school clubs? (1)

(eg 9, 10, 11, 12)

School club activities (Membership, offices held)

What grades did you participate in school clubs? (2)

(eg 9, 10, 11, 12)

School club activities (Membership, offices held)

What grades did you participate in school clubs? (3)

(eg 9, 10, 11, 12)

Other school activities (Athletics, drama, speaking)

What grades did you participate in other school activities? (1)

(eg 9, 10, 11, 12)

Other school activities (Athletics, drama, speaking)

What grades did you participate in other school activities? (2)

(eg 9, 10, 11, 12)

Other school activities (Athletics, drama, speaking)

What grades did you participate in other school activities? (3)

(eg 9, 10, 11, 12)

OUTSIDE ACTIVITIES

Organizations: (Offices in churches, clubs, scouts, Red Cross, etc.)

What grades did you participate in organizations (1)

(eg 9, 10, 11, 12)

Organizations: (Offices in churches, clubs, scouts, Red Cross, etc.)

What grades did you participate in organizations (2)

(eg 9, 10, 11, 12)

Organizations: (Offices in churches, clubs, scouts, Red Cross, etc.)

What grades did you participate in organizations (3)

(eg 9, 10, 11, 12)

Honors and awards won

What grades did you earn the honor or award? (1)

(eg 9, 10, 11, 12)

Honors and awards won

What grades did you earn the honor or award? (2)

(eg 9, 10, 11, 12)

Honors and awards won

What grades did you earn the honor or award? (3)

(eg 9, 10, 11, 12)

Individual activities, hobbies

What grades did you participate in individual activities/hobbies? (1)

(eg 9, 10, 11, 12)

Individual activities, hobbies

What grades did you participate in individual activities/hobbies? (2)

(eg 9, 10, 11, 12)

Individual activities, hobbies

What grades did you participate in individual activities/hobbies? (3)

(eg 9, 10, 11, 12)

Are you ready to submit your application?

Yes

Not Yet