HIGHLAND PARK/HIGHWOOD ROTARY CLUB SCHOLARSHIP APPLICATION

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1 HIGHLAND PARK/HIGHWOOD ROTARY CLUB SCHOLARSHIP APPLICATION PLEASE RETURN COMPLETED APPLICATION TO THE CRC BY MARCH 31st, 2017 Thank you for your interest in applying for the Highland Park/Highwood Rotary Club (HPRC) scholarship program. The goal of this program is to provide qualifying students from Highland Park High School who have a demonstrated financial need with monetary scholarship that will enable them to attend a College or a University of their choice. Over the years, HPRC has assisted scores of students in realizing their goal of a college education. In the last four years alone, HPRC awarded 39 scholarships totaling $102,000. To qualify as a HPRC scholar, you must be a high school senior attending Highland Park High School. You should have a strong academic record with a GPA of 2.75 or greater, and you must demonstrate real financial need. If you are selected as a scholarship recipient, you will be required to agree to the terms of a HPRC Scholarship Agreement which includes expectations for academic standards, commitment to community service, and active participation in Rotary sponsored events, in order to renew your award and maintain scholarship privileges. Please read the attached Scholarship Agreement prior to completing the application. Application for the HPRC scholarship must be completed and returned by 4/8/16. All information must be filled in or the application will not be considered. If an item is not applicable, write N/A. If you have questions, contact your college counselor Highland Park/Highwood Rotary Club welcomes all qualified applicants.

2 Student Information Legal Name: Enter name exactly as it appears on official documents or passport. First Last Suffix(Jr., etc) Address: Street City State Zip Home phone Date of birth (mm/dd/yy) Cell phone Place of birth (city, state, country) Gender Current High School Information Guidance counselor: Cumulative GPA (weighted) Cumulative GPA (unweighted) ACT score SAT score (combined) Anticipated College/University:

3 School Activities List high school-related activities in which you have participated Activity Office(s) Held Dates Of Participation Hours per week Community/ Volunteer Activities List community activities in which you have participated without pay Organization Activity/Service Dates Of Participation Hours per week

4 Please describe briefly, which of these activities you have found particularly important or meaningful, and tell why. Employment List any jobs you have held during your high school years, including summers. Employer Job/Type of Work From (mm/yy) To (mm/yy) Hours per Week

5 Family Information The People You Live With (Circle the Correct One) Mother Step-Mother Guardian (Circle the Correct One) Father Step-Father Guardian Name (First and Last) Country of Birth Employer s Name Occupation - Parent s Marital Status Married Divorced Widowed Separated Never Married Other Children living in the home (attach additional sheet if necessary) Name Age School Attending Next Year

6 Estimated Family Income Section (dollars only) All information below is to be based on current year (2016) estimates. Income from people you live with: Father/stepfather s income $ Mother/stepmother s Income $ Income from parents you don t live with (if applicable) $ Child Support Per Year (if applicable) $ Social Security Benefits (if applicable) $ ADC or General Assistance (if applicable) $ TOTAL FAMILY INCOME $ Extraordinary Expenses for 2016 Medical/Dental $ Legal Fees $ Other (please explain) $ Other Financial Information If own home, estimated equity in home $ Total amount in savings accounts, stocks, $ bonds or other investments Total amount in IRAs or college funds $

7 Student Essay Questions Please answer each question completely. Use separate sheet of paper for each response. Responses should be 250 words or one full page each. 1. What are your goals? How will this scholarship help you achieve these goals? 2. What are your greatest strengths and weaknesses as a student? As a person? Letter of Recommendation (REQUIRED) With this application, you must submit a letter of recommendation on your behalf from either a high school teacher or a guidance counselor. In their letter, they should discuss things such as your leadership qualities, intellectual promise, concern for others and community at large, and any special personal accomplishments. The recommendation should not be more than one full typed page. The letter of recommendation should be in a sealed envelope with the name and /phone number of the person recommending you clearly written on the front. Required Certifications Applicant Certification Applicant Certification I certify that the information provided in this application is, to the best of my knowledge, true and correct. I have not knowingly withheld any facts or circumstances that could otherwise jeopardize consideration of this application. If selected to receive a scholarship, I give permission for the release of application materials (excluding financial information) for promotional purposes Signature of Applicant: Date: Parent/Guardian Certification Parent/Guardian Certification I certify that I have reviewed the Application Checklist in the Application Instructions and that all requested information has been provided. I certify that the family and financial information provided in the application is, to the best of my knowledge, true and correct. Signature of Parent/Guardian: Date:

8 Application Check-list 1. Unofficial copy of your high school transcript 2. Two Essays (250 words, or one full page for each 3. Completed Application, including required signatures 4. Written recommendation from teacher or guidance counselor 5. Photocopy of FAFSA SAR or of most recent tax return Release of Information (must b

9 Highland Park/Highwood Rotary Club Scholarship Agreement College bound students who are awarded, and accept, HPRC Scholarship, agree to the following terms and conditions: 1. Maintain a minimum cumulative G.P.A. of 2.0 and carry the minimum number of credit hours each semester to graduate in four years (2 years for a community college). 2. At the end of each school year, provide the proof of academic standing to the Rotary Club. 3. Perform at least 10 hours of Community Service during each school year, and provide documentation validating your work and hours to the Rotary Club 4. Attend at least two Rotary Club sponsored events each calendar year 5. Continue to demonstrate high motivation, responsibility, and integrity

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