KIWANIS CLUB OF APPLETON, WI GOLDEN K SCHOLARSHIP

Scholarship Award: $1,000 non-renewable scholarship to one student from each of the five Appleton High Schools,

(Appleton East, Appleton North, Appleton West, Xavier, and Fox Valley Lutheran.)

Scholarship candidates will be evaluated on the following basis:

  • Minimum cumulative 3.0 GPA
  • Residency in the Appleton Area School District
  • Plan to pursue a degree at an accredited college or university (two or four year) or a technical college
  • Participation in school activities
  • Participation in community activities
  • Work experience

Students’ applications are due in their Guidance Office byMarch 1

The application packetsmust include:

Complete application

Grade transcript

ACT/SAT scores

Student essay

Questions may be directed to the Community Foundation for the Fox Valley Region at (920)702-7619, or .

APPLICANT INFORMATION

Name:______Sex: M F (circle)

Address:______

City:______State:______Zip:______

Home Phone:______Cell Phone:______

Email:______Date of Birth:______

EDUCATION

Name of school currently attending:______

GPA:______Graduation Date:______

Date and time of High School Awards Ceremony:______

Education Institution you plan to attend in fall:______

First Choice:______Second Choice:______

Have you been accepted at your first choice?YesNoIf no, when do you expect to be notified:______

Have you been accepted at your second choice? YesNoIf no, when do you expect to be notified:______

Intended Major:______

ESSAY QUESTION (Attach separate sheet if necessary)

Please respond to the following question in 100 words or less:

Why is furthering your education important to you?

EMPLOYMENT (Attach additional sheet if necessary)

List jobs and type of work you have held.

Name of Employer / Dates of Employment / Type of Work / Hours worked per week
COMMUNITY SERVICE (Attach additional sheet if necessary)

List volunteer work or community service you performed without pay starting with the most recent. Please list approximate total hours of work/service, not average hours per week.

Name of Organization / Dates of Participation / Type of Work/Service / Total Hours of Work/Service
EXTRACURRICULAR ACTIVITIES INVOLVEMENT (Attach additional sheet if necessary)

List your extracurricular activities involvement, starting with the most recent. Attach extra pages if necessary.

Activity / Dates of Participation / Specify Leadership Position Held
OTHER SCHOLARSHIPS

List all scholarship for which you have applied

Name of Scholarship / Annual Amount (indicate over how many years) / Status: unknown, approved, pending

Application Certification:

I hereby certify that the information given in this application is accurate and complete to the best of my knowledge. I understand that misrepresentation in any statement may be considered reason for disqualification and/or repayment of any scholarship. If I am awarded a scholarship, I agree to abide by all requirements and responsibilities of the award. I understand that should I be named as a scholar, any non-financial information in the application could become available to the public. I further understand that according to federal tax laws, the scholarship(s) will be taxed as ordinary income if used for purposes other than qualified education expenses. (Information can be found at

Applicant’s Signature: ______Date: _____/_____/______

Printed Applicant Name: ______

Allstudent applications must be received intheir Guidance Office by March 1

High School Counselors–Please forward therecipient’s application to:

Community Foundation for the Fox Valley Region

4455 W. Lawrence St.

Appleton, WI 54914

Fax: 920-830-1293

Email: