THE ROTARY CLUB OF YORK SCHOLARSHIP APPLICATION FORM

PLEASE FILL IN FORM COMPLETELY BEFORE PRINTING (Note: Macros must be ENABLED)

Personal Information

Name: Last First MI

Address at which mail will always reach you

Street CityState Zip

Phone Date of BirthEmail

Scholastic Information

High School Graduation Date Class Rank

Students in graduating class Cum GPA out of

SAT scores Verbal Math Writing TOTAL

College/University Field of study

Expected date of graduation

List participation in extracurricular and/or community activities

Yearly Expenses / Yearly Income
Tuition / / Federal/state loans /
Room/Board / / Federal/state grants /
Other School Expenses / / Scholarship aid /
College grants /
Parents Contribution /
Student Contribution /
Other Sources of Funding /
TOTAL / /

Do you plan to work at school and/or during vacation periods to earn money for your education? Yes No

Explain:

Do you have any other grant or loan requests pending? Yes No If yes, give details:

Name(s) of Parent(s) or guardian(s):

Father

LastFirst

Address:

Street CityStateZip

Mother

LastFirst

Address if Different from Father:

Street CityStateZip

Required Documentation

  • Two letters of reference from people unrelated to you who have known you for at least 3 years. One must be from a teacher or guidance counselor
  • A copy of your FAFSA “Student Aid Report” printed from computer or sent to you by the U.S. Department of Education *(Do not hold application for SAR – submit copy of FAFSA application instead)
  • A copy of your most recent high school report card AND an official transcript.
  • A copy of the essay sent with your college application.
  • For the Kable scholarship, a one page essay as described in the cover letter.
  • Copy of your college acceptance letter and Financial Aid package offered by college.
  • A recent wallet sized photo of applicant.

Scholarship money will be paid to the college or university to which you will attend.

Scholarship money for the Engineering Society’s Edgar Kable scholarship will be paid directly to the student.

Signatures

I certify that the information I have provided on this application is true and accurate to the best of my knowledge.

______

Student’s signatureDate

Please return this application form NO LATER THAN MARCH 31

with the required documentation to:

The Rotary Club of York, C/O Yorktowne Hotel, 48 E. Market Street, York PA 17401

Phone: (717) 848-1370

Email:

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