ROTARY CLUB OF WILLOWBROOK

WRC Foundation Scholarship application

Willowbrook Rotary Foundation Scholarship

 Fall 2013 Application Form

 

 

I,  _________________________, will graduate from Klein or Cy Fair ISD in spring 2013 and plan to begin my college education starting with the fall semester of 2013.

 

I understand that this scholarship award is for two academic years with payments of $625 per semester beginning with the fall semester of 2013 for a maximum of $2,500.

 

I understand that applicants must have overcome challenges either academic or social, be willing to discuss these challenges, and have a current GPA of at least 2.5 (on a 4.0 scale). In addition to completing this application form I understand that I must attend an interview by the Willowbrook Rotary Selection Committee (“Selection Committee”) in early May 2013.

 

I understand that in order to accept this award I must attend an accredited local two year college. I also understand that if I do not enroll in the fall of 2013, I will relinquish this entire scholarship award.

 

I understand that maintaining my eligibility requires achieving a 2.5 GPA, completing a minimum of 9 hours for each fall and spring semester and attending at least one Willowbrook Rotary meeting or function per semester.

 

Note: All completed scholarship application forms must be received by May 1, 2013.

 

 

(Student Information)

 

Student’s Full Name__________________________________________________________  

 

Name of High School _________________________________________________________

 

Student’s Home Address: Street ________________________________________________

 

                                          City & Zip Code_________________________________________

 

Home Phone Number _______________ Cell Phone Number ________________________

 

Student’s e-mail Address _____________________________________________________

 

(Note:  It is important that we are able to contact and stay in communication with you.  Please notify us of any changes in your contact information.  Also, let us know the best way to reach you.)

 

Have you applied for admission to a trade school or two year college? _________________

 

List school(s) where you have applied.____________________________________________

 

Have you been accepted? __________ 

 

Student’s Signature & Date _____________________________________________________

 

 

Student Financial Information (To be kept strictly confidential)

 

Indicate your family’s IRS adjusted gross income for 2012: _______________

 

Do you contribute to your family income by paying any of your car, insurance, or personal expenses? __________ If yes how much per year ___________

 

Do you contribute to your family income in any other manner? __________If yes, please explain: ___________________________________________________________________

 

Indicate the number of individuals (including parents and dependents) in your household ___

 

How many of these individuals will be enrolled in college or trade school in the fall 2013 semester?  (Including applicant) __________

 

If you work (outside the home) how many hours per week do you work? __________

 

What type of work do you do? ___________________________________________________

 

Who do you work for? __________________________________________________________

 

How much is your income? (Hourly or per year) ______________________________________

 

List one work reference and telephone number: ______________________________________

 

List any other scholarships, loans or financial aid you have or will apply for and indicate if you have been accepted: ____________________________________________________________________________

 

____________________________________________________________________________ 

 

 

(Student Activity Information)

 

Please list up to ten (10) volunteer, community, and school sponsored activities you participated in during high school: ____________________________________________________________________________

 

____________________________________________________________________________

 

 

 

Essay Section, Completed only by the student and attached to the application

Note: there are two essay requirements; (a) career aspirations and (b) challenges overcome.

 

(a)  In your own words describe your career goals, intended major in two-year College.

 

(b)  In your own words describe academic and/or social challenges you have overcome.

     

 

(Principal/Counselor Provided Information)

 

Student: All information above to be included and given to your Principal/Counselor for completion and submittal. The information below is to be filled out and signed only by your Principal/Counselor. This application will not be accepted without the required information, validated and signed.

 

Student GPA (adjusted to a 4-point scale): ____Please provide a transcript with this application

 

Indicate if the student’s GPA is weighted for honors or other advanced classes (yes/no).

 

Indicate if the student's GPA has been impacted by a social or personal event (yes/no). If yes, please discuss: ____________________________________________________________________________

 

____________________________________________________________________________

 

 Principal/Counselor, please give your reasons why this applicant should be chosen:

 

____________________________________________________________________________

 

____________________________________________________________________________

 

____________________________________________________________________________

 

____________________________________________________________________________

 

____________________________________________________________________________

 

____________________________________________________________________________

 

 

 

____________________________________________________________________________

 

 

Signature of Principal or Counselor and title:

 

__________________________________________ Date: _____________________________

 

 

Principal/Counselor: The completed application, including essays, is to be returned to the Willowbrook Rotary Club, Attention: David Thompson, 16602 Aldenham Place, Spring, TX 77379.  Note: All completed scholarship application forms must be received by May 1, 2013.

 

Willowbrook Rotary Club will consider all applicants and selection of the recipients is at the sole discretion of its Selection Committee. The Selection Committee bases its decision solely on the responses on the application and the personal interview.

 
Sponsors