Oshkosh Southwest Rotary Service Scholarship Application

OSHKOSH SOUTHWEST ROTARY SERVICE SCHOLARSHIP APPLICATION

Scholarship Deadline: 2/20/17

1. APPLICANT INFORMATION

Name:______

Mailing Address: ______

City, State, Zip: ______

Telephone: ______Email: ______

High School: ______Month & Year of Graduation: ______

2. HIGH SCHOOL ACADEMIC PERFORMANCE

Cumulative Grade Point Average: ______

Does your high school use a weighted GPA (such as for honors or advanced placement courses): Yes No

Number of Advanced Placement, Honors, or Advanced Courses: Senior Year: ______Junior Year: ______

ACT Composite: ______SAT Critical Reading: ______SAT Math: ______SAT Writing: ______

Include all scores if you have taken both exams.

3. STUDENT WORK EXPERIENCE

Most recent employer: ______

Job Title: ______Average Hours/Month: ______

From (month/year): ______To (month/year): ______

Next most recent employer: ______

Job Title: ______Average Hours/Month: ______

From (month/year): ______To (month/year): ______

4. COMMUNITY VOLUNTEERISM (charity work, scouting, church etc.)

Volunteer Activity Leadership Position (if any) Hours/Month Years Involved

______Fresh Soph Jr Sr

5. CO-CURRICULAR ACTIVITIES (clubs, sports, student government, etc.)

Co-Curricular Activity Leadership Position (if any) Hours/Month Years Involved

______Fresh Soph Jr Sr

6. SCHOOL OR COMMUNITY AWARDS

Award Awarded By Years Awarded

______Fresh Soph Jr Sr

7. COLLEGE INFORMATION

Anticipated Undergraduate Major or Program of Study: ______

Type of School: Four-Year College or University Technical or Community College Junior College

Other (Please specify: ______)

Level of Attendance: Full-Time Part-Time

1st choice or If applicable,

current school: ______2nd choice school: ______

City, State: ______City, State: ______

Next year’s anticipated expenses at this school: and at 2nd choice school, if applicable:

Tuition: $______Tuition: $______

Room & Board: $______Room & Board: $______

Books & Supplies: $______Books & Supplies: $______

Total: $______Total: $______

8. 4-WAY TEST ESSAY

Please write an essay to address the 4-Way Test that Rotary has adopted as the cornerstone of all its actions. As an ethical decision making tool, describe how the 4-Way Test has directly affected your life. (Please limit your response to 2 pages)

9. DESCRIBE WHY YOU ARE DESERVING OF THIS SCHOLARSHIP

Scholarship Deadline: 2/20/17

Feel free to email any questions regarding the scholarship application and/or email your application to or mail your completed scholarship application to:

Oshkosh Rotary Southwest

Attn Scholarship Committee

PO Box 1202

Oshkosh WI 54903-1202