Carrollton Rotary Club Scholarship Application P.O. Box 631 Carrollton, KY 41008

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1 Carrollton Rotary Club Scholarship Application P.O. Box 631 Carrollton, KY Name Date Last First MI Home Phone Birth date M F Soc. Sec. Num. Name of School you will attend Have you been accepted? Y N Major: Estimated cost/year Financial Information Name of father's employer Position held Name of mother's employer Position held Number of dependents (excluding self) in: Elementary School Middle School High School Post Secondary Name any other scholarships for which you have applied: Have you been awarded any of the above? If so, which one(s) Are you eligible to receive federal assistance under the Veteran's Orphan's Law? Y N Are you eligible for assistance as a child of a disabled veteran? Y N Are you eligible for any other federal financial aid? Y N If yes, which one? I hereby verify that above information is true and accurate to the best of my knowledge and I agree to submit proof of the same upon request, if necessary. I also agree that if scholarship funds are provided to me, and I am unable to complete the educational program for which the monies were issues, I will repay the monies to the Carrollton Rotary Club. Signature - Applicant Signature Parent/Guardian Date Date

2 Educational Information High School, College Address Dates of Degree Or G.E.D. Attendance or Diploma Personal Information (Please describe any awards or recognitions you have received that would have a bearing on a scholarship award. Also, describe any professional, community-related, or educational activities in which you have been involved that would lend support to your application. Employment Information: List two or three most recent jobs you have held. Employer Location Dates Hrs/week Job Description To be filled out by the Principal Principal's estimate of applicant's future success based on the goals of this applicant: Little Success Some Difficulty Average Above Ave. Superior Principal's recommendation: Recommended Not recommended Prefer not to make a recommendation Date Signature Principal or Guidance Counselor may attach additional information to better demonstrate the abilities and aptitudes of this student, such as: high school transcript or teacher recommendation. PLEASE ATTACH A TRANSCRIPT TO THIS APPLICATION. Return completed application to the Guidance Office by March 16

3 Carrollton Rotary Club P.O. Box 631 Carrollton, KY Dennis Raisor, Treasurer General information to potential recipients: Please note that scholarship monies will be paid DIRECTLY TO THE RECIPIENT S SCHOOL. The recipient must provide the following in order to have scholarship payment made: Fall Semester: Proof of registration including class schedule and bill showing amount due. Spring Semester: Proof of registration and transcript of grades showing satisfactory progress. Payments will be made on the following schedule: July 1, 2018 for fall semester November 1, 2018 for spring semester Communication with the treasurer of the Carrollton Rotary Club, only, is necessary to release funds. Funds will not be released on the word of the principal, friends, pastor, or other persons. Scholarship awards are in the following amounts: $1,000 on an academic year to a 4-year college or university $ 500 on an academic year to JCC/Carrollton for full time students $ 250 on an academic year to JCC/Carrollton for part time students

4 1. Applicant must be a resident of Carroll County (Exceptions will be allowed for some specifically named scholarships.) 2. Scholarship monies are ONLY TO BE GIVEN TO STUDNETS WHO ATTEND JEFFERSON COMMUNITY AND TECHNICAL COLLEGE IN CARROLLTON, KENTUCKY, in conjunction with his/her acceptance. 3. The scholarship award must be used within a twelve-(12) month period from the date received. 4. The scholarship monies will be paid directly to the school as noted on the scholarship award certificate. It will apply toward tuition, books, and other fees. Funds in excess of actual expenses will not be disbursed. 5. If the recipient does not complete the education program for which the scholarship was issued, all monies paid out will be considered a loan and must be paid back to the Carrollton Rotary Club. Criteria: The following criteria will be considered in the awarding of the Rotary Scholarships: 1. Academic Performance 2. Financial Need 3. Citizenship 4. Demonstrated commitment to career goals (internships, clubs, employment etc) 5. Acceptance to post-secondary institution (or pending acceptance) Procedure Submit the following. 1. Application completed by applicant and returned to above address with 2. all supporting information. 2. A one (1) page written statement of personal and educational goals. 3. Letter of reference/support from a community member. 4. Report completed by High School Principal (if applicable) 5. Letter of reference from current or former employers (if applicable) 6. Transcripts from high school and any post-secondary course work already completed

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