Kiwanis C a l - N e v - H a F o u n d a t i o n www.cnhfoundation.org P.O. Box 247 Rancho Cucamonga, CA 91730-0608 Office: 909-989-1500 Fax: 909-989-7779 Email: foundation@cnhkiwanis.org Kiwanis Cal-Nev-Ha Foundation Scholarship Application Instruction Page Cali-Nev-Ha Key Club & Cal-Nev-Ha KIWIN S Key Club Received by Deadline: February 15, 2016 Note: Applications received after this date will NOT be considered by the judging committee. Mail to: Kiwanis District Office, Attn. Service Leadership Programs Scholarships 8360 Red Oak St., Suite 201, Rancho Cucamonga, CA 91730-0608 Please clearly separate scholarship applications from convention registration and contest entries. This application will also be used as the initial application for the Loretta Barksdale McElwain scholarship with a value of approximately $20,000.00. Applicants will be requested to submit separately the Free Application for Student Aid (FAFSA) Student Aid Report to be considered for this award. Instructions: Please read all instructions before beginning the application process! 1. FOLLOW DIRECTIONS!!! 2. The application is divided into three sections but weighed differently a. Service as a Kiwanis Member (CNH/KIWIN S Key Club only) 60% of your score b. Service to your School (other than CNH/KIWIN S Key Club) 20% of your score c. Service to your Community (other than CNH/KIWIN S Key Club) 20% of your score NOTE: Duplication of activities in more than one section will not be considered by the judges. Specifically comment on your contribution to the project. Statements like 10/2006 Organized PTP car wash; 20 members; raised $5000 carries more weight with the judges than, Car Wash 10/2006 3. Applicant must be a high school senior who plans to enroll full time in a college, university, or institution of higher education the next year. 4. Applicant s name must appear on both District and International dues forms from the current year. 5. Complete the application. a. Limited to this pdf-fillable form only (Acrobat Reader is needed): Any modification or change to this form will not be considered by the judges. 1) You are limited to the number of slots provided. 2) If you see a plus sign in corner of the cell, you need to rewrite your description using fewer words. b. Entire application (except for signature lines) must be typed. ADOBE READER USERS: Form must be printed without saving. c. Times or Times Roman font only (Form default) d. Font size must be 9-point or higher (Form default) e. No attachments! 6. Tips: Use dates. Record specific accomplishments, number of people served, awards received and recognition given. Provide sufficient information so the judges understand the nature of the project and your involvement in the project. Building a better future for our children
Kiwanis C a l - N e v - H a F o u n d a t i o n 8360 Red Oak Street, Suite 201 Rancho Cucamonga, CA 91730-0608 Office: 909-989-1500 Fax: 909-989-7779 Email: foundation@cnhkiwanis.org Kiwanis Cal-Nev-Ha Foundation Scholarship Application Cover Page www.cnhfoundation.org Cali-Nev-Ha Key Club & Cal-Nev-Ha KIWIN S Key Club Received by Deadline: February 15, 2016 I am applying for the following CNH scholarship. CNH Key Club or KIWIN S Key Club Note: Applications received without a category designation will NOT be considered by the judging committee. Applicant Name Last Name First Name Middle Initial PERSONAL INFORMATION Address Street City State Zip Home Phone Cell Phone Social Security # E-mail KIWANIS FAMILY INFORMATION # of years in CNH/KIWIN S Key Club? Previous K-Kids Member? (Y/N) Years Parent(s) members of Kiwanis? (Y/N) Previous Builders Club Member? (Y/N) Years MEMBERSHIP INFORMATION (Obtain from club secretary or Key Club International) Member Identification # Region Division Club Club Identification # Sponsoring Kiwanis Club ACADEMICS Applicant is a high school senior who plans to enroll full time in a college, university, or institution of higher education next year. (Y/N) Applicant s FAFSA Student Aid Report will be available if requested? (Y/N) Academic (weighted) G.P.A. This school does not weigh grades. (check if appropriate) Verified by: Name Signature (select one) Faculty advisor Counselor School Registrar EMPLOYMENT Did you hold a job during high school? Where? Average # of hours worked each week? I verify that all information contained herein is correct Typed Name of Applicant Signature of Applicant Date Building a better future for our children
THIS LINE IS FOR CNH KIWANIS FOUNDATION USE ONLY Applicant # (Obtain from club secretary or district dues report) Current club membership? What year was this club chartered? # of years in CNH/KIWIN S Key Club? Total # of CNH/KIWIN S Key Club service hours? CNH/KIWIN S KEY CLUB SERVICE 60% of your score Indicate service completed as a CNH/KIWIN S Key Club member, projects chaired, service projects organized, events attended, offices held, etc. Indicate only the top twenty (20) service projects that you completed as a CNH/KIWIN S Key Club member. Alumni Luau Service Project 6-07 Recruited 40+ members to volunteer; coordinated on site assignments Junior High School Mentor Program 11 th - 12 th grade Mentored two 7 th grade students in math & science Your service:
KEY CLUB Kiwanis Cal-Nev-Ha Foundation Scholarship Application Page 3 of 4 Indicate only the top fifteen (15) Kiwanis Family events that you attended as a CNH /KIWIN S Key Club member. Key Club International Convention 2010/ 2011/ 2012 Attended Tour & ICON; delegate each time; Social Media Team volunteer Kiwanis Club of Endor Senior Year Two per month; gave club report to Kiwanis & Kiwanis report to club Indicate up to your top ten (10) offices or positions held and up to your top ten (10) honors received as a CNH/KIWIN S Key Club member. Indicate whether office positions are elected or appointed positions. Leadership Positions Held Recognition or Honors Received When did Elected or Date (list Name of the office or position you serve? Appointed? Name of the recognition multiple dates Division 100 Lt. Governor 2006-2007 Elected Member of the Month together) 4/2004, 10/2007 PTP Car Wash Project Chair 2005-2006 Appointed Top Fundraiser: UNICEF 10-2006 Your leadership positions: Your awards and recognitions:
KEY CLUB Kiwanis Cal-Nev-Ha Foundation Scholarship Application Page 4 of 4 SERVICE TO THE SCHOOL 20% of your score Indicate offices held (other than CNH/KIWIN S Key Club) and participation in other organizations and projects. Indicate up to your top ten (10) offices held and participation in school organizations and projects not affiliated with CNH/KIWIN S Key Club. Yearbook 11 th grade Sports Editor Orchestra 9 th -12 th grade Violin, 3 rd chair; Viola, 1 st chair SERVICE TO THE COMMUNITY 20% of your score Indicate organizations and projects you were involved in through your religious institution, other community service groups not affiliated with Kiwanis or your school, and any activities accomplished on your own. Indicate up to your top five (5) community service activities not affiliated with Kiwanis or your school. Sunday School 2007 Taught 2 nd grade classes each week Camp Sunshine 8 weeks, 2007 YMCA summer camp counselor; Crafts Instructor