ROTARYINTERNATIONALDISTRICT7120
DISTRICT 7120 GLOBALSCHOLARAPPLICATIONFORM2014-2015
Notesto applicants:Beforecompletingthisapplication,pleasereadthescholarshipsinformationon Search for the documents entitled Global Grant Scholarships Supplement and Terms and Conditions for Rotary Foundation District Grants and Global Grants.
Thisapplicationmustbesubmittedonlinewithallattachmentsnolater thanFebruary 1, 2015 to:
Dr. Kenneth T. Steadman, Chair, District 7120 Scholarship Committee
Email:
Lateapplications will notbeaccepted.ApplicationssubmitteddirectlytoTheRotaryFoundationwillnotbeconsidered.
Applicantsacceptedforaninterviewmustbeavailableinpersonforaninterviewtobeheldat the Geneva Public Library at a date and time TBA between February 24-March 9, 2015.
Following selection, candidate will work with a District 7120 Foundation representative to complete the Rotary Foundation Global Grant Application. District 7120 will be the international partner for the application. A District in the country where the university is found will be the host partner for the application. The total value of the grant must be exactly $30,000. Candidates must affirm ability to cover costs in excess of the grant.
FIELD OF STUDY MUST FIT INONEORMOREOFTHEFOLLOWINGAREAS:(Pleasemarkyourarea(s)offocusandaddaone-pagedescriptionofyourscholarship programwithprojectedtimelinesandestimatedbudgetsincluded.)
PeaceConflictResolution
DiseasePreventionTreatment
WaterSanitation
MaternalChildHealth
BasicEducationLiteracy
EconomicCommunityDevelopment
Pleaseprintlegiblyortype.Donotuseinitialsorabbreviations.
Familyname:Givennames:
MaleFemaleCurrentmailingaddress:
Email:
Telephone:Telephone(alternative):Countryofcitizenship:
Countryofbirth:
PermanentMailingaddress(Please list if differentfromcurrentmailingaddress)
Emergencycontactinformation(relationship,name,address,phonenumber,email):Name: Relationship: Address: Telephone:
Email:
ProposedfieldofstudyattheInstitutionandlengthofstudyprogram.
Institution and Program: ______
Length of Study: ______
Note:
Pleaseindicateifyourprogramofstudyhasthe flexibilitytobeginineitherthefallsemesterorthewintersemester. Attachestimated budget. See Sample Budget Guidelines at the end of this document for eligible and ineligible expenses. If you intend to conduct a service project in conjunction with your program of study (again, within the area of focus), include cost estimates and timeline for the project.
Note:
Study program must be at the graduate level in an institution outside of the United States, cannot commence prior to approval of the global grant application, and scholar must reside in the host Rotary District (where the university is located).
EDUCATIONAL HISTORY
Postsecondaryoruniversitylevel(includeanystudiesplannedbetweennowandthescholarshipterm;listplannedormostrecentstudiesfirst):
Institution: City,State/Province,Country: Datesattended: ______
Fieldof study: Degreeorcertificatereceivedorexpected:
Institution: City,State/Province,Country: Datesattended: ______
Fieldofstudy:
Degreeorcertificatereceivedorexpected:______
SecondarySchoolattended:Datesattended(monthandyear)
Diplomaorequivalent
YesN
Language Skills ______
EMPLOYMENT HISTORY
(Listcurrentormostrecentfirst)
Name of employerJobtitle ortypeof work
Datesworked(monthyear)
PREVIOUSEXPERIENCEABROAD
State/ProvinceCountryDatesCircumstances
ESSAYS
PreparethefollowingdocumentswithyournameandRotaryInternationalDistrict7120in the upperrightcorner.
1.Abriefautobiography,nolongerthantwopages,describing
a.Academicstrengthsandchallenges;
b.Workexperience related to the Area of Focus for your study; and
c.Careerobjectives.
2.Adetailedstatementofintent,nolongerthantwopages,describing
a.Yourreasonsforapplyingforascholarshipandhowyourcourse of studyfitswithinoneormoreofthesixareasoffocusof RotaryInternationalandtheRotaryFoundation;
b.Yourproposedfieldofstudyandfuturecareerplans related to it; and
c.Yourprincipalinterestsandactivitiesandanyleadershippositionsyouhaveheld. Indicateanytrainingorexperienceinpublicspeakingorcommunityservice.
ImportantReminders:
Estimatedbudgetmustbeincludedforyourintendedprojectandforallyourgraduateschoolexpenses,includingtuition,books,fees,residence,food,insurance,travel,etc.ThisGlobalScholarshipisforexactly $30,000.00(U.S.dollars). The Candidate must affirm ability to cover costs in excess of the grant.
LETTERS OFRECOMMENDATION
Havetwoacademicinstructorsoremployersorsupervisorsprovidelettersofrecommendation.
TRANSCRIPTS
Provideoriginaltranscriptsfromallpost-secondarycollegesoruniversitiesattended.
STUDY INSTITUTION
Detailsregardingyourproposedstudyinstitutionandacademicorresearchprogramshouldyoubeawardedascholarship.
Name of institution:
City,State/Province,Country:
Websiteaddressof institution:
Datesof attendance ______
Nameofspecificdegreeorcertificateprogram: ______
Websiteaddressofdegreeorcertificateprogram: ______
Once selected by District 7120, applicants for a scholarship must apply for acceptance at the proposed university and program of study desired, if not done already. Scholar must be accepted at the proposed university/program at the time District 7120 submits the application for a global grant to fund the program. The global grant application must be submitted at least three months before studies are to begin.
APPLICANT’SCERTIFICATION
Mysignaturebelowcertifiesthattheinformationprovidedinthisscholarshipapplicationistruthfulandaccurate.Ialsocertify thatin order toabidebyRotaryInternational’sconflictofinterestpolicyrelatedtoindividualsreceivinggrantfundsIdonotfitinanyofthecategorieslistedbelow:
- Rotarian,includinghonoraryRotarian
- Employeeofaclub,district,orotherRotaryEntity,orofRotaryInternational
- Spouse or linealdescendant of a Rotarian (childorgrandchildbyblood,legaladoption,ormarriagewithoutadoption),spouseoflinealdescendants,orancestor(parentorgrandparentbyblood)ofperson(s)intheabovecategories
- Employeeofanagency,organization,orinstitutionthatpartnerswithTheRotaryFoundationorRotaryInternational
- FormerRotarianorhonoraryRotarianwhohasterminatedmembershipwithinthepreceding36months
- PersonwhoisineligiblebasedonafamilialrelationshiptoaformerRotarianorhonoraryRotarian,foraperiodof36monthsafter terminationoffamilymember’smembership
It is importantforapplicants to understandthat iftheyare selected, therewill be specificinsurance requirementsthat must be obtained. Ifselectedfor theGlobalScholar program,Iagreeto purchaseallrequiredinsurance, includingtravel,medicalcare hospitalization, aswellasaccidentillness,and/oremergencymedicalevacuationinsurance.
Ifselected,Iagree to participatein a pre-departureorientationsponsored by District 7120 of Rotary International.
Ifselected,Iagree to provide periodic required written reports to the designatedpersonat RotaryInternationalDistrict7120. Reports must include receipts for expenses.
I agree to submit to a random drug test if requested conducted at a date and time selected by a representative of District 7120. Illegal drug use disqualifies a candidate from further consideration.
Signature: Date: ______
SAMPLE BUDGET GUIDELINES
Postapproval/Pretravel
Passport/Visa
Eligible: Cost of obtaining a passport and visa
Innoculations
Eligible: Cost of inoculations
Not eligible: Cost of Doctor appointment
Medical Insurance
Eligible: comprehensive international medical insurance (as specified in the grant terms and conditions) for the duration of the scholarship
Not eligible: travel insurance
During Study Period
Eligible School Supplies: books, workbooks, computer
Other eligible items: Tuition and school fees, Room and Board (excluding alcohol), Household supplies, Transportation, Study related travel
Other Ineligible expenses:
Any expenses incurred before the application is approved by the Rotary Foundation (application fees, language exam fees, etc.)
Purchase of furniture, automobile, bicycle
Clothing
All expenses for spouses or dependents
Housing expenses in the home country during the scholarship period
Any taxes owed as a result of receiving the scholarship
Medical care (including dental care)
Entertainment
Personal travel
Expenses related to Rotary events
Note: most personal and miscellaneous expenses are not covered by the scholarship funding.