Rotary Memorial Scholastic Foundation, Inc. Sponsored by The Rotary Club of Yuba City

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1 Rotary Memorial Scholastic Foundation, Inc Sponsored by The Rotary Club of Yuba City APPLICATION The Rotary Memorial Scholastic Foundation, Inc is a California non-profit corporation created in 1983 under the sponsorship of the Rotary Club of Yuba City It was established to create a permanent fund to assist and encourage graduates of Sutter County high schools who have demonstrated leadership potential and scholarship ability to pursue a college education Scholarships are awarded to as many students as there are funds available during the spring of each year Awards range between $1,000 and $3,000 Payments to the recipients are made upon proof of registration in an accredited college or university Applications should be filed directly with the name of the person given below The Foundation directors select a committee to review the applications and personally interview the finalists In selecting the Rotary Scholar, academic achievement, leadership potential and extra curricular activities, as well as financial need, will be taken into consideration The scholarships will be awarded on a non-discriminatory basis, and they are open ONLY to graduates of Sutter County High Schools THE DATA SHEET: RECOMMENDATION: TRANSCRIPT REQUEST: FILING: PERSONAL INTERVIEW: Instructions and Checklist Leave no blanks; all the questions aid us in determining your eligibility for an award, whether based on need and/or achievement Give this part of the form to a professor, teacher or counselor to complete and return direct to us at the address below Have copies of high school or college transcripts sent to the address below Applications must be received no later than_may 2, 2016 Finalists will be required to appear and be interviewed by the selection committee Submit completed applications and all related information to: Rotary Memorial Scholastic Foundation, Inc Del Pero & Del Pero Attorneys at Law 1408 Live Oak Blvd Suite B Yuba City, CA OR you may the completed applications to 1

2 ROTARY MEMORIAL SCHOLASTIC FOUNDATION, Inc DATA SHEET NAME: Last First MI PERMANENT (HOME) MAILING ADDRESS State of Birth Permanent Street Address / / Date of Birth Permanent City and State MAILING ADDRESS DURING SCHOOL YEAR ( ) (if different than home address) Telephone Number address Local Street Address: In the Fall, I will be (check one): Entering college at Local City and State: ( ) Zip Code Telephone Number Continuing college at Status in the Fall will be (check one): Freshman Junior Sophomore Senior Self-reported cumulative GPA through High School or last Fall Semester of College: List all other Scholarships actually received I permit all of the above information to be disclosed to third parties for the purpose of scholarship consideration If I am selected I authorize release of biographical information for use in publicity related to the scholarship program Applicant's Signature Date EDUCATION List all high schools and colleges attended (including your present school) with dates of attendance and graduation If you have attended college, indicate the number of quarter units (1 semester equals 15 quarter units) you have completed, the number of units earned through advanced placement examinations, and the number of units for which you are currently enrolled Dates of Dates of School Location Attendance Graduation Quarter Units Currently Enrolled Quarter Units Completed Quarter Units Earned - AP Exams 2

3 ROTARY MEMORIAL SCHOLASTIC FOUNDATION, Inc TRANSCRIPT REQUEST Applicant s Name: LAST FIRST MIDDLE INITIAL IF YOU ARE A: SUBMIT: COMPLETED BY: High School Student High School Transcript High School Registrar or Counselor Continuing College Student College Transcript - all colleges College Transcript Office All college work completed to date attended and College work completed Registrar or Counselor REGISTRAR OR COUNSELOR: After completion of the following, DO NOT RETURN THIS FORM TO THE STUDENT Please send it, along with the transcript directly to: ROTARY MEMORIAL SCHOLASTIC FOUNDATION, INC Del Pero & Del Pero, 1408 Live Oak Blvd Suite B, Yuba City, CA TRANSCRIPT: Submit a transcript of academic work completed through the end of the most recent term TEST SCORES: SAT: ACT: GRADE-POINT AVERAGE: Indicate the student's overall cumulative GPA I certify that the information reported above is true and correct Signature Date Title: School: Telephone: ( ) 3

4 ROTARY MEMORIAL SCHOLASTIC FOUNDATION, Inc RECOMMENDATION Name of Applicant: LAST FIRST MIDDLE INITIAL This form is to be completed by a teacher, counselor, or someone knowledgeable of the student's academic abilities or special skills who can BEST evaluate the student's potential for achievement Scholarships are awarded on the basis of academic excellence or promise of future achievement academically Financial need is an additional criterion Grade point average, extracurricular activities, offices held, and honors won has been listed elsewhere on the application; they need not be repeated You should comment on the applicant's intellectual characteristics, leadership, and personality traits Personal experiences with the applicant, which serve to illustrate aptitude for higher education, are particularly helpful Please include any extenuating circumstances that would cause the applicant's record not to reflect true ability Return this form directly to the Rotary Memorial Scholastic Foundation, Inc Del Pero & Del Pero, 1408 Live Oak Blvd Suite B, Yuba City, CA Signature School Printed Name & Title Date 4

5 ROTARY MEMORIAL SCHOLASTIC FOUNDATION, Inc ACTIVITIES / EMPLOYMENT Name of Applicant: LAST FIRST MI Extracurricular Activities & Organizations and any offices held (please list): Hobbies, personal interests, favorite books, and magazines or newspapers (please list): Employment: Where, when, and your duties (please list): PERSONAL ESSAY On a separate page, write a brief essay about yourself and your educational pursuits The essay should indicate your main area of academic interest, why you chose it, and any special qualifications you may have Tell us about yourself and your life goals Please ATTACH this 500 WORD (or less) TYPEWRITTEN essay TO this page The essay must NOT exceed 500 words While GPA is important this essay will weigh heavily in your consideration for scholarship awards ROTARY MEMORIAL SCHOLASTIC FOUNDATION, Inc FINANCIAL INFORMATION Name of Applicant: LAST FIRST MIDDLE Please itemize and set forth the relevant information below Please be sure to include information as to what plans you have for financing your college education Please tell us if you plan to work part-time or if you are willing to work parttime in order to complete your education and whether or not you will receive financial assistance from your parents, or any other source Please TYPE your information on a separate page using the financial assistance heading given above, and please do NOT exceed 300 words 5

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