Randolph Metrocom Rotary Club P.O. Box 2381 Universal City, Texas 78148 210.200.8519 scholarship@randolphmetrocomrotary.org Service Above Self Academic and Vocational Scholarship Application Instruction Form The Randolph Metrocom Rotary Club is proud to announce its 2017 Service Above Self Academic and Vocational Scholarship for $1,000.00. This scholarship is awarded to the student who best epitomizes the Rotary Club motto of Service Above Self. A. Eligibility Requirements 1. The applicant must be a high school senior attending a school in one of the following school districts or be homeschooled in the Randolph Metrocom Area*: a. Judson Independent School District b. Schertz/Cibolo/Universal City Independent School District c. Marion Independent School District d. Randolph Independent School District 2. All applicants must have applied to and/or been accepted for enrollment as a fulltime undergraduate student at an accredited college or other approved institution in the United States. Documented proof from the institution of full-time enrollment is required. 3. All applicants must demonstrate Service Above Self through a history of school and/or community service. B. Procedures 1. The deadline for submitting applications is May 1, 2017. 2. Required documents: a. Copies of the applicant s most recent high school transcript along with the checklist on the cover of the application. *The Randolph Metrocom Area consists of Cibolo, Converse, Garden Ridge, Kirby, Live Oak, Marion, New Berlin, Schertz, Selma, Universal City and Windcrest.
Page 2 of 2 b. Two (2) letters of recommendation attesting to the applicant s character and community service. c. The applicant must complete and include the Permission to Release Information form with the application. 3. If the applicant becomes a finalist, he/she must be available for a personal interview with the Scholarship Committee before their application is considered. 4. This scholarship can be used only for educational tuition. The scholarship will be paid directly to the educational institution. 5. The winner must attend at least one Randolph Metrocom Rotary Club meeting during the first year of having received the scholarship. 6. The winner must attend the Randolph Metrocom Rotary Club Installation Banquet (time, place and location to be announced). The time and place will be provided to the scholarship recipient.
Randolph Metrocom Rotary Club P.O. Box 2381 Universal City, Texas 78148 210.200.8519 scholarship@randolphmetrocomrotary.org SERVICE ABOVE SELF SCHOLARSHIP APPLICATION FORM Date Name (Last, First Middle) Date of Birth Mailing Address City State Zip Telephone Number ( ) Email Address How long have you lived in the Randolph Metrocom area? Schools Attended, 9 th through 12 th Grade: Name of School Date of Entrance Grades Attended Year of Graduation # of Students in Class Expected Rank in Class Expected GPA SAT Score ACT Score College/Vocational School of Choice College/Vocational School Address Date of Application Have You Been Accepted? ONLY FULLY COMPLETED APPLICATIONS WITH REQUIRED SUPPORTING DOCUMENTS WILL BE CONSIDERED
Page 2 of 4 List Other Financial Assistance You Have Applied for or Received: Source Amount Applied For or Received? List your extracurricular activities and what you gained from those activities: Have you had any paying jobs while attending high school? Y N If so, please state the name of the employer, the period of time employed, a brief description of your responsibilities and the hours per week you worked: List any Rotary projects/events you have participated in: Why did you choose the college/vocational school for which you are applying or have been accepted? ONLY FULLY COMPLETED APPLICATIONS WITH REQUIRED SUPPORTING DOCUMENTS WILL BE CONSIDERED
Page 3 of 4 In 250 words or less, state how you have demonstrated Rotary s motto Service Above Self in your life. ONLY FULLY COMPLETED APPLICATIONS WITH REQUIRED SUPPORTING DOCUMENTS WILL BE CONSIDERED
Page 4 of 4 If you are awarded the Scholarship, please indicate the date funds need to be available and the address where they should be mailed. State the number of Service Hours required by your high school: Community Service Hours performed: List your community volunteer activities and what you gained from those activities: * If you need more space than allocated for answers, please attach page(s). If so, please type your full name on the top of the page(s) and note the item in the Application about which you are writing. ONLY FULLY COMPLETED APPLICATIONS WITH REQUIRED SUPPORTING DOCUMENTS WILL BE CONSIDERED
Randolph Metrocom Rotary Club P.O. Box 2381 Universal City, Texas 78148 210.200.8519 scholarship@randolphmetrocomrotary.org PERMISSION TO RELEASE INFORMATION TO THE RANDOLPH METROCOM ROTARY CLUB To: Financial Aid Director College/Vocational School City/State/Zip I have applied for a scholarship from the Randolph Metrocom Rotary Club. All of my required documents have been submitted to the Randolph Metrocom Rotary Club and my file is complete. I hereby authorize you to discuss my eligibility to receive the grant by telephone, fax, email or mail with a representative of the Randolph Metrocom Rotary Club. Failure to submit this form in a timely manner may result in my being ineligible to receive a scholarship. You may be contacted by a member representing the Randolph Metrocom Rotary Club after May 1, 2017. Your support and cooperation will be appreciated. Signature of Student Date Student Name (print) Signature of Parent/Legal Guardian Date Parent/Legal Guardian Name (print) Sign this form and send it to the Financial Aid Office at your college/vocational school. Submit a copy of this signed form with your application.
Randolph Metrocom Rotary Club P.O. Box 2381 Universal City, Texas 78148 210.200.8519 scholarship@randolphmetrocomrotary.org Service Above Self Scholarship Application Checklist Please initial all and include this checklist with your application. I meet all of the qualifying conditions for the scholarship. I have attached two letters of recommendation. I have attached the permission to release information form. I have to the best of my knowledge filled out the form completely and honestly. If awarded the scholarship, I will attend the Randolph Metrocom Rotary Club Installation Banquet (date, time and place to be announced). The time and place will be provided to the scholarship recipient. If awarded the scholarship, I will attend a meeting during the year and speak about my academic/vocational experience. Name (please print) Signature Date Please note: To be considered as an Applicant, all items above must be initialed.