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.