Rotary Club of Charlotte South

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Scholarship Award: up to $5,000 per year for up to 4 years (maximum $20,000 award) Initial Scholarship Requirements: 1. Student must have attended the Rotary Club of Charlotte South Beach Blast while in Middle School. 2. Student must submit an original short essay based on the Rotary 4-Way Test (details follow). 3. Application along with Essay must be submitted to Rotary Club of Charlotte South no later than March 15, 2016: Mail to: Rotary Club of Charlotte South Scholarship Application 7804 Fairview Road PMB# 188 28226 Or e-mail the information to 4. Student must be graduating from High School and be planning to attend a higher learning institution which can include any United States based Trade School, Community College, 2-year or 4-year College or University. 5. The student must be enrolled full time and in an accredited program at their higher learning institution. 6. The winner will be determined no later than June 1, 2016. 7., past or present, are not eligible for the Scholarship. Scholarship Winner and Award: 8. To receive initial year funding up to $5,000, the winner must provide proof of High School graduation and be accepted to the higher learning school and provide documentation to Rotary Club of Charlotte South at the same address above. 9. The Scholarship award may be used for tuition, room and board, and/or books. 10. Funding will be paid directly to the higher learning institution, without exception. Ongoing Scholarship Requirements: scholarship award and funding, winner must: 1. The student must be in good standing with their higher learning institution and maintain a 2.5 GPA. The student must provide a school transcript verifying GPA to Rotary Club of Charlotte South no later than July 31 st of each year to receive funding for the fall semester and January 31 st of each year for the spring semester. 2. Provide a letter once per year to Rotary Club of Charlotte South giving an update on the 3. Attend one Rotary club meeting during the 12 months prior to the current years funding, to provide a short update on their academic progress and how Rotary has impacted their education. Preferably the meeting would be at Rotary Club of Charlotte South, but if not possible, any Rotary Club can be attended to meet this requirement. Note: Unqualified funds, used and claimed during the year awarded will be considered forfeited and will not be funded. No candidate can be awarded or denied scholarship based upon religion, race, r gender.

Essay Create an original short essay based on the Rotary 4-Way Test Of the thi ngs w e think, say, or do: 1. I s i t the TRUTH? 2. I s i t FAI R to AL L concer ned? 3. W ill i t bui ld GOOD W I LL & BETTER FRI ENDSH I PS? 4. W ill i t be BENEFI CI AL to ALL concer ned? 1) Apply the Rotary 4-Way Test to a real life situation or challenge. Consider your peers as your audience. 2) Essays should be single-spaced, 12-point Times New Roman type, pages numbered, and approximately 400 words. 3) Your essay must be original and reflect your personal content. Apply the Rotary 4- Way Test to an important real-world issue in everyday life and relationships. To be fair to all, DO NOT mention your name, school, city, or any references to any other information that could personally identify you or your family. The essay may be published in the Rotary Club newsletter/website. 4) Personal testimony and real-life application of the 4-Way Test is encouraged. Use stories, facts, statistics, examples, and quotations as appropriate. Be careful not to include too many statistics. You may share an experience when you (or someone else) did or did not abide by the 4-Way Test, and how you used that experience as a growth or learning opportunity. Be creative feel free to add humor and personal touches. All content should be respectful and appropriate for diverse audiences. Here are a few questions to start the creative process (NOT an outline): How does the Rotary 4-way test challenge you in your everyday life? How would you live it out and encourage others to do the same? Who lived out the 4-way test in a way that inspired you? How may you be challenged by the 4-way test in the future? 5) Sign and date your essay. Submit in accordance with Item 3 on preceding page.

ROTARY BEACH BLAST 4-W AY TEST SCH OL ARSH I P ESSAY Students: Complete the identifying information and sign the application and release form portion (with parent/ guardian signature). APPLI CATI ON AND RELEASE FORM (To be completed by student and parent/ guardian Signatures are required.) By signing this release, I indicate my willingness to reproduce my essay, and to be published in any form. I affirm my willingness to participate, as my schedule permits, in brief speaking engagements as requested by Rotary Club of Charlotte South. I also grant permission to the scholarship selection committee to verify all information submitted on, or in support of this application. I understand and meet all eligibility requirements. I understand that the decision of the selection committee is final. Name: Preferred name: (Last) (First) (Middle) Street Address: City, State, Zip E-Mail: Phone #1: ( ) - Phone#2: ( ) - Schools considering attending for higher education: Area of study being considered for higher education (if known): Student signature: Date: Parent / Guardian Name(s): Relationship: Parent/ Guardian Signature: Email: SCH OOL CERTI FI CATI ON The student is currently a Senior and plans to graduate high school. The student attended the Rotary Beach Blast while in middle school. School Counselor: Name (print): Signature: Email: Date: Name of High School: Year Student attended Beach Blast: Middle School attended while attending Beach Blast:

List thr ee r efer ences (non -fam ily m em ber s): School related reference: Name: Indicate type (Teacher, Counselor, Coach, etc.): Reference Address: Reference Contact information: Community Related Reference (not a school employee) Name: Indicate type (Business, Community, Church, etc.): Reference Address: Reference Contact information: Other Reference (not a school employee) Name: Indicate profession or relationship: Reference Address: Reference Contact information: Other Activities Please list any community, school organizations, extracurricular activities or other activities or offices held that might be indicative of your activity levels and/ or leadership abilities.

ROTARY 4-W AY TEST SCH OLARSH I P CH ALLENGE Essay Judging Rubr ic Student Num ber Cr iter ia (Rate 1-5, 5 = superior) Content: Originality, Clarity, Documentation, Reasoning, Accuracy, Sufficiency, Relevant to peer audience Or ganization : Purpose, Introduction, Transitions, Conclusion Unity of essay/ speech, Integration of Theme Language: Clarity, Expressiveness, Grammar, Pronunciation, Appropriateness (relevant for peers/ professionals) Effectiveness of Them e (4-W ay Test): Integration/ Communication of Rotary 4-Way Test Knowledge/ Application/ Reinforcement of Theme Total Scor e (5-20) Rater Date Points Notes: