FALMOUTH ROTARY SCHOLARSHIP

Declaration of Intent and Selection Criteria

The Rotary Club of Falmouth is proud to offer scholarships this school year to graduating seniors of PendletonCountyMemorialHigh School.

Graduates are eligible for consideration whether they are going to a four year program, two year program, or technical school. The student does not have to be a member of a Rotary organization but any student having participated in Rotary activities will be given extra consideration.

Selection criteria is based on need along with academic performance and extra-curricular school and community activities. The questions on this application have been designed to help the Selection Committee determine the student’s financial need, dedication to learning and willingness to share their talents with the community. Students may improve their chances of selection by filling out this form neatly and truthfully.

All applications are confidential. After selection of recipients is made, the data including the recipient’s name and the amount of scholarship, along with general information may be recorded and maintained by the school. Otherwise, all original documents will be destroyed. The Falmouth Rotary Club will only keep the information for a limited time.

DO NOT INCLUDE this sheet, a cover sheet or any other documentation other than additional sheets for questions 6 and 7.

FALMOUTH ROTARY SCHOLARSHIP APPLICATION

Name______Contact #______

Last First Middle I.

  1. With which institution do you wish to continue your education and why?

2. Have you participated in a Rotary Club service Project? (circle one) Yes No

(If yes, list the project (s) and the year (s) you have been involved:

3. List siblings:

NAME / AGE / SCHOOL ATTENDING

4. What is your current unweighted GPA? ______

5. What is your net (after taxes) family income? This includes income from stocks, rent,

securities, annuities, trust, and other “unearned” income. (circle one)

a. less than $19,999 b. $20,000 - $39,999 c. $40,000 - $59,999

d. $60,000 - $79,999 e. more than $80,000

6. What community clubs, organizations, or activities are you involved in? What position did

you hold in these groups? (you may attach a separate sheet of paper)

7. What school clubs, organizations, or activities are you involved in? What position did you

hold in these groups? (you may attach a separate sheet of paper)

8. Do you have a part time job? (This includes babysitting, farm work, or any other

responsibility that requires more than one hour a day.