Rotary Club of Portsmouth Scholarship Application Each year the Portsmouth Rotary Club seeks scholarship applicants from high school seniors scheduled to graduate, who will be attending a post secondary institution, and who reside in the City of Portsmouth or in the adjoining Towns of Rye, Greenland, New Castle or Newington. The scholarships are one-time, non-recurring awards of up to $2000 and are made on a non-discriminatory basis to individuals demonstrating excellence in scholastic, extracurricular and community service activities. Recipients are notified approximately six weeks after the application deadline. The scholarships are awarded during a Rotary meeting in May or June. Individuals with special learning circumstances, who have demonstrated a capacity to overcome such circumstances, are encouraged to apply for the scholarships. Applicants are encouraged to work with their high school guidance counselor and/or college advisor when submitting the following application. From the pool of applicants, the Portsmouth Rotary Scholarship Committee will select a pool of finalists who will be interviewed individually in April. (v) (vi) GENERAL APPLICATION GUIDELINES Please answer all questions in the prescribed format; incomplete applications may not be considered. Resumes will not be accepted or reviewed Use additional sheets of paper only in necessary to more fully answer a question(s). Two (2) letters of reference are required and must be attached to the application. An official high school transcript must be included with your application. Transcripts at Portsmouth High School may be obtained from Jean Fleischmann in the Guidance Office. Applications must be mailed to the following address and be POSTMARKED no later than APRIL 1, 2010. (vii) ADDRESS: Rotary Scholarship Committee c/o Portsmouth Music and Arts Center Attn: Russ Grazier 75 Albany Street Portsmouth, NH 03801 1
APPLICANT INFORMATION (Please print or type) 1. Name: 2. Current Mailing Address: 3. Home Telephone Number: 4. Cell Phone Number: 5. E-mail Address: 6. Date and Place of Birth: 7. Name(s) of Parent(s) or Guardian(s): 8. Parent(s) or Guardian(s) Address: 9. Name of High/Secondary School: 10. Date of Graduation: 11. Please check the following boxes to verify the following documents are included with this application. Applications received without the following documents will be considered incomplete and will not be considered by the review committee. Complete High School Transcript Academic Letter of Reference (from a Teacher, Guidance Counselor, or other school officer) Community Letter of Reference (from a non-family member, employer, friend, mentor) Copies of any Financial Assistance Award Notifications you ve received (other scholarships or awards) 2
APPLICATION QUESTIONS 12. Estimated tuition expense for the first (1 st ) year of the college you are most likely to attend: $ 13. Amount you have personally saved for your first (1 st ) year college expenses: $ 14. How were the savings in 13 (above) earned? Over what period of time? 15. Does your family/guardian intend to assist you with your college expenses? If so, to what extent? 16. Highest level(s) of education attained by parents? Father: Mother: 17. Father s (guardian s) total annual income (include income earned on investments, if any): $ 18. Mother s (guardian s) total annual income (include income earned on investments, if any): $ 19. Total number of dependents in your household: 20. Total number of family members who will be attending a post-secondary school on not less than a half time basis during the upcoming school year, including the applicant: 21. Do you plan to work or be engaged in a work/study program while attending college? 3
22. Please list all other scholarships/grants/work study you have applied or plan to apply for. Provide a copy of the notification of any financial assistance awarded by your college, and or any other organization(s): 23. Special Scholastic honors or awards: (Please list all) HONOR OR AWARD SCHOOL YEAR 24. Extracurricular Activities (List all activities in which you were engaged during school grades 9-12. Indicate offices or positions held and average hours per week devoted to each activity, and any special recognition (all-state, festivals, etc.)) ACTIVITY SCHOOL YEAR 4
25. Athletic Activities (Identify sports in which you participated during grades 9-12. Indicate level of competition (Varsity, JV, Intramural, Club) and any special recognition (letter, all-state, district champion, etc.)) SPORT SCHOOL YEAR LEVEL SPECIAL RECOGNITION 26. Employment experience (List, indentify type(s) of employment, hours worked, relationship of job to career goals if applicable, and supervisor s name and address) 27. Community Service (List community service activities in which you participated during school years 9-12. Indicate average number of hours per week involved and please provide supervisor s name and address) ACTIVITY AVG. HRS. PER WEEK SUPERVISOR S INFO 5
28. College/School plans (List the colleges or post-secondary schools to which you have applied or intend to apply. Indicated planned major, and whether accepted or not.) EARLY COLLEGE/SCHOOL MAJOR ACCEPTED DECISION YES/NO (v) 29. What do you expect to get out of your college experience? 30. What are your post-graduate career goals? 31. Why should you be selected to receive this scholarship? What sets you apart from others who will be competing against you? 32. What serves as your internal moral or ethical compass? (optional) 6
I (applicant) hereby certify that the foregoing referenced is accurate and complete. Signature: Date: FOR USE ONLY BY COMMITTEE Notes: 7