EDEN ROTARY SCHOLARSHIP

APPLICATION AND NOMINATION

Date ______Name ______

(First) (Middle) (Last) (Call Name)

Section A: Personal Data

Social Security # ______

Current Address: ______

(Street) (Apt #)

______

(City) (State) (Zip Code)

Home Telephone: (______) ______Date of Birth: ______

(Month) (Day) (Year)

Parents or Guardians:

Father: Name ______Occupation: ______

Address: ______

(Street) (Apt #)

______

(City) (State) (Zip Code)

If any, College Attended / Degrees Earned ______

Mother: Name ______Occupation: ______

Address: ______

(Street) (Apt #)

______

(City) (State) (Zip Code)

If any, College Attended / Degrees Earned ______

How many brothers/sisters do you have? Older ______Younger ______In College _____ High School _____

Note: When completing application, please feel free to attach additional pages when needed.

Section B: Scholastic Records and Personal Plans

  1. Scholastic Record
  1. Grade Point Average: ______(Unweighted)

Note: Must have a 3.0 GPA or higher to apply

  1. Attach most recent transcript
  1. Personal Plans
  1. Briefly state your educational plans, and list occupations or professions you are considering at this time. If unsure at this time, please list “Undecided”.
  1. List colleges to which you are applying / have applied for admission. Also, indicate if you have been accepted or are still waiting for a response.

College Pending / Accepted

______

______

______

______

______

  1. List all scholarships you have applied for, the scholarship amount, and if you have been awarded the scholarship or not (if you know at the time of this application).

Scholarship Dollar Amount Awarded/Not Awarded/Still Pending

______

______

______

______

______

______

______

______

______

Section C: Activities (Please include all academic, athletic, community, and personal activities. Also, only list each activity once.)

  1. Please list all offices held, honors and/or awards received
  1. Please list all extracurricular activities and number of year(s) of participation
  1. Academic
  1. Athletic
  1. Community
  1. Work / Volunteer Experience
  1. Hobbies / Interests

Section D: Leadership

  1. In the space provided below, please describe your most significant leadership role, and relate what you consider your most important accomplishment in that role.

Section F: Service Above Self (Essay: 250 words or less)

Rotary International’s main credence is “Service Above Self”. In your own words, what does “service above self” mean to you. Also, include an example in which you have put service above self during your high school career.

EDEN ROTARY SCHOLARSHIP

Student’s Signature: ______

Parent / Guardian Signature: ______

Guidance Counselor’s Signature: ______

Please mail completed application by April 15, 2012 to:

Eden Rotary Club

Attn: Scholarship Chairperson

PO Box 3212

Eden, NC27289-3212