Las Vegas Southwest Rotary Club Academic Scholarship Application Form for 2019

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The Las Vegas Southwest Rotary Club will award one $9,600 to a graduating senior for the academic year 2018-2019 who intends to attend a public college or university in Nevada, i.e., UNLV, UNR, Nevada State College or other public college in Nevada. The $1,200 scholarship (per semester) will be awarded on a per-semester basis and is renewable for up to 8 semesters of college as long as the applicant maintains a 3.0 GPA (on a 4.0 GPA maximum) and completes a minimum of 12 semester hours per semester. The scholarship will be paid directly to the school you are attending for your account. Required eligibility requirements: 1. Graduating from a Northwest Accredited high school in Clark County, Nevada. 2. A minimum weighted or non-weighted 3.5 GPA. 3. Demonstrate a family or student financial need. Desired eligibility requirements: 1. A minimum composite ACT score of 25 or a SAT score of 1,500 2. Demonstrate leadership in school and/or community. 3. Must be a legal resident of the United States To apply please send the completed scholarship packet postmarked by April 1, 2019: 1. Application form 2. A recent photo 3. Financial need statement 4. Seven semester official transcript, including recent national test scores 5. A 750 word essay on the topic Why Las Vegas Southwest Rotary should award me this scholarship Incomplete and late applications will not be considered; please review your application carefully before your submission to: Las Vegas Southwest Rotary Club Scholarship Committee PO Box 70126 University Station Las Vegas, NV 89170-0126 1

STUDENT INFORMATION Name of applicant Social Security Number Date of birth Address City State ZIP Code High School of Enrollment Parent or Guardian Relationship Address (if different from applicant) City State ZIP Code Home phone Cell phone Are you a U.S. Citizen if no, are you an eligible non-citizen List your Alien registration number A Please list all post high school institutions that you have applied to: Please list all scholarships and/or grants that you have applied for and/or received: Signature of Applicant Date 2

Student Profile Community Service list the volunteer work you have completed during high school. Indicate the service organization and what you did. Leadership in high school list all positions you have held including the year. You can describe what you did in those leadership roles. Awards and Honors list all that you have received in high school and indicate what your grade level was when the award/honor was received. 3

Parent or guardian of applicant: Financial Need Statement Occupation Employer Parent or guardian of applicant (other parent or guardian if working): Occupation Employer Copy of your parent(s) most recently filed Income Tax return including schedules; please black out the social security numbers on the copy of the return. Other income source(s), besides the scholarships and grants listed on page 2, that you will use towards your college expenses: Amount Source Amount Source Are there other members of your family currently attending college? Yes / No Number of children in your family, including applicant Please add any information you feel will strengthen your candidacy for this scholarship. Parent or guardian signature Date 4

For School Official Use Only Rank in Class Number in Class GPA cumulative GPA weighted SAT Scores ACT Score Critical Reading Math Writing Signature of School Official and Title Please attach the Official seven-semester transcript here. 5