ROTARY CLUB OF CHATHAM

THE FOUR-WAY TEST

Of the things we think, say or do, Is it the TRUTH? Is it

FAIR to all concerned? Will it build GOODWILL and

BETTER FRIENDSHIPS? Will it be BENEFICIAL to

all concerned?

SCHOLARSHIP APPLICATION

  1. ELIGIBILITY

The Rotary Club of Chatham will award ONE $2,500 scholarship to a current graduate of James M. Hill who will be pursuing post-secondary studies.

Sons and daughters of Rotary Club members are ineligible to apply.

  1. CRITERIA

Academic Achievement: This scholarship will be awarded to a student who has maintained a good, consistent academic record

Community involvement:Applicants must demonstrate their contributions in volunteering in community activities.

Financial Needs:Applicants must provide information on his/her financial status and how he/she will finance his/her education. It is expected that students will disclose all scholarships and bursaries known at the time of application.

Attach a one page summary of your volunteer work in your community and describe what this meant to you and the organizations. Maximum of one (1) page.

  1. PRESENTATION

This award will be presented by the President of the Chatham Rotary Club or designate at the graduation. The student will be invited to a Rotary Club meeting to be recognized.

The disbursement of the award will be in two parts: 50 % will be paid when the student provides proof of registration at a post secondary institution; the remaining 50 % will be paid when proof of satisfactory first-term results are submitted.

  1. APPLICATION DEADLINE

May 15 of each year. No late applications will be accepted.

Applications must be submitted to the Principal.

  1. SELECTION OF SCHOLARSHIP RECIPIENT

A committee comprising of Rotarian members will review all applications and make a selection of award winner.

The Rotary Club of Chatham awards this scholarship based on the information provided in the application. Incomplete applications may not be accepted. Additional information may be requested from the school in making the final selection.

  1. COPY OF CURRENT HIGH SCHOOL MARKS

Ensure most recent transcript is attached.

  1. PERSONAL INFORMATION

______

Name in Full Telephone Number

Street City/Province Postal Code

______

S.I.N. Date of Birth Marital Status

Post-Secondary Institution You Plan to Attend: ______

Career Goal: Program of Studies: ______

If dependent on parents, number of persons dependent

On parents (including yourself):______

Parents Gross Income:______

If married, number of dependants:______

Spouse Gross Income:______

Indicate where you will be living while attending college/university:

With Parent ______Own Home ______Boarding/Renting ______

Involvement in volunteer community activities:

ACTIVITY / POSITION / LENGTH OF PARTICIPATION
  1. FINANCIAL INFORMATION:

Resources (estimate):

Personal Contribution to program (from savings, employment, etc.)$ ______

Student Loan Amount Received (for first year)$ ______

Government Sponsorship (ie: EI Benefits, training allowances)$ ______

Spouse/parental contribution$ ______

Other scholarships, bursaries$ ______

TOTAL RESOURCES$ ______

Expenses (estimate)

Tuition $ ______

Books and Lodging$ ______

Transportation$ ______

Daycare$ ______

Other (specify)$ ______

TOTAL EXPENSES$ ______

PRIVACY STATEMENT: The information contained in this application is used strictly to determine eligibility for the award and will not be used or shared for any other purpose.

  1. Attach one page summary maximum describing your community volunteer work and what this meant for you and the organizations you contributed to.
  1. I CERTIFY THAT THE INFORMATION SUBMITTED ON THIS APPLICATION IS CORRECT. I UNDERSTAND THAT APPLICATIONS CONTAINING MISREPRESENTED INFORMATION WILL BE DISQUALIFIED.

______

Signature of ApplicantDate

NOTE: Pleaseensure your marks and one page Volunteer Summary are attached.

VOLUNTEER SUMMARY

______

Signature of ApplicantDate

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