Harrisonburg Kiwanis Club
Raymond Dingledine Scholarships
The Harrisonburg Kiwanis Club will award several $2000 scholarships to graduating seniors from Harrisonburg High School. Scholarships may be used at any accredited two or four year college of the student’s choice; however, business or secretarial school applications will not be considered. Scholarship funds will be paid directly to the chosen college at the beginning of their first academic year.
To be eligible, successful applicants must:
1. Attend the Kiwanis Scholarship Awards Dinner to be held in May.
2. Submit a COMPLETE APPLICATION PACKET to the Harrisonburg Kiwanis Club (via Mrs. Linden in the Counseling Center) by March 1.
The COMPLETE APPLICATION PACKET must include the following:
o The completed, typed scholarship application form.
o A single page, typed essay entitled “My contribution and service to the community” with student author’s name and date below the title.
o A completed School Counselor recommendation form in a sealed envelope (The counselor completing the form must sign across the sealed flap.)
o Two (2) single page letters of recommendation in sealed envelopes (The reference member’s signature must be written across the sealed flap.)
o The signed checklist form.
3: Submit the entire application packet in a large envelope.
The Kiwanis Club Scholarship Awards Committee will select scholarship winners. All information received will be considered confidential. The decision will be made primarily on the basis of financial need, extent of community service as described in the essay, and promise of success in college. The committee reserves the right to consider only qualified applicants. Decisions made by the Harrisonburg Kiwanis Club Scholarship Committee are final.
If you have additional questions or comments concerning the program, please contact:
Dr. Gerald Taylor, Jr.
Kiwanis Scholarship Awards Committee
1110 South Dogwood Drive
Harrisonburg, VA 22801
Phone: 540-433-1251
Applications are available from the Counseling Center.
Deadline for receipt of application by your Counseling Center is March 1.
Harrisonburg Kiwanis Club
School Counselor Recommendation Form
I request that ______of Harrisonburg High School provide the
(School Counselor)
the following information about me to the Harrisonburg Kiwanis Club so that I may compete for a $2000 Harrisonburg Kiwanis Club Raymond Dingledine Scholarship.
______
(Student’s Signature)
This Section for Completion by School Counselor
Instructions: Please place the completed School Counselor Recommendation Form in a sealed envelope. Write your name across the sealed flap, and give the envelope to the student requesting a recommendation. The applicant will include your recommendation along with their application form and two letters of recommendation to the Harrisonburg Kiwanis Club Scholarship Awards Committee. Your recommendation will be held in confidence and may be mailed directly to the chair of the Kiwanis Scholarship Awards Committee if you wish. Deadline for the receipt of recommendation by Kiwanis Scholarship Awards Committee is March 1, 2018. Thank you for assisting the Awards Committee in its evaluation of scholarship applications.
Gerald Taylor, Ph. D.
Kiwanis Scholarship Awards Committee
1110 South Dogwood Drive
Harrisonburg, VA 22801
540-433-1251
Student’s Grade Point Average: ______Rank in Class: ______Out of: ______
SAT Scores: EBRW: ______Math: ______
Overall, I would recommend this student for college work:
1. Without Qualification: ______
2. With Qualification: (Please explain.) ______
Degree of financial need based on your knowledge (if known). PLEASE CHECK ONE:
1. ___Severe need* 4. ___Slight need
2. ___Strong need* 5. ___No great need
3. ___Moderate need
*If school counselor wishes to provide additional information in view of severe or strong need, please use the reverse side of this form. Thank you.
Harrisonburg Kiwanis Club
Raymond Dingledine Scholarship Application
Checklist to Include With Application
Applicant’s name typed: ______Date: ______
Applicant’s telephone/cell number: ______(necessary if the committee needs to contact you)
If awarded, the $1,500 scholarship will be paid directly to the two year or four year college of your choice for your first academic year as a full-time student enrolled in an accredited program of study.
Instruction: Check each item included in your application packet.
1. _____ Completed (typed or word processed) application
2. _____ Essay (typed) entitled “My contribution and service to the community”
3. _____ Completed school counselor recommendation form
______Included ______Mailed by counselor
4. _____ Two single page letters of recommendation
______Included ______Mailed by recommenders
5. _____ Completed checklist
Instruction: Submit the entire application packet in a large envelope by March 1.
The Harrisonburg Kiwanis Club Scholarship Awards Committee reserves the right to consider only qualified applicants and the decision of the Committee is final. Scholarship recipients are expected to attend the Harrisonburg Kiwanis Club Awards Banquet and Program to be held in May in Harrisonburg.
If I am awarded a Harrisonburg Kiwanis Club Raymond Dingledine Scholarship, I will attend the Awards Banquet of the Harrisonburg Kiwanis Club in May.
Applicant’s signature: ______Date: ______
Harrisonburg Kiwanis Club
Raymond Dingledine Scholarship Application Form
(Please type all information requested.)
Name: ______Date: ______
Address: ______
______U.S. Citizen: Yes □ No □
Phone/Cell Number: ______Name of High School: ______
If employed, list name of employer: ______
How many older brothers and/or sisters do you have? ______How many younger? ______
Father’s name: ______Mother’s name: ______
Address: ______Address: ______
______
Occupation: ______Occupation: ______
Employer: ______Employer: ______
Parents’ average yearly income for the past 3 years: ______Do they own a home? _____
Have you been awarded scholarships from any other sources: YES _____ NO _____
If yes, specify sources and amounts: ______
______
Please identify the college you plan to attend and the academic program in which you plan to enroll (or if undecided, those to which you are applying): ______
______
______
List the names and addresses of the two (2) individuals, not relatives, whose letters of recommendation are being submitted in sealed envelopes with this application.
1. ______2. ______
______