Willowbrook Rotary Club
Interact Club Scholarship
Fall 2014 Application
I, ______, will graduate from Klein, Klein Forest or Klein Collins high school in the spring of 2014 and plan to begin my college or other higher level education starting with the fall semester of 2014. I have been an active member of my high school’s Interact Club for at least one year. (Klein students exempted from one year requirement this year since Interact Club just recently inaugurated.)
I understand that this scholarship award is for two academic years with payments of:
· Two-year colleges or vocational/trade schools. $625 per semester beginning in the fall semester of 2014 for a total of $2,500.
· Four-year colleges. $1000 per semester beginning in the fall 2014 for a total of $4,000.
I understand that applicants must be an active member of your high school’s Interact Club, have exhibited a commitment to the Rotary motto ‘Service Above Self’ and have a current GPA of at least 2.5 (on a 4.0 scale). In addition to completing this application form I understand that I must attend an interview by the Willowbrook Rotary Club’s Selection Committee in early May 2014.
I understand that in order to accept this award I must attend an accredited local two-year college, trade school or an accredited four-year university. I also understand that if I do not enroll in the fall of 2014, I will relinquish this entire scholarship award.
I understand that maintaining my eligibility requires maintaining a minimum 2.5 GPA, completing a minimum of 9 hours for each fall and spring semester and attending at least one Willowbrook Rotary meeting or function per semester.
Note: Scholarship applications must be completely filled out and received by April 15, 2014 to be eligible.
- Student Information
Student’s Full Name______
Name of High School ______
Student’s Home Address: Street ______
City/Zip Code______
Home Phone Number ______Cell Phone Number ______
Student’s e-mail Address ______
(Note: It is important that we are able to contact and stay in communication with you. Please notify us of any changes in your contact information. Also, let us know the best way to reach you.)
Have you applied for admission to a two or four-year college or a trade school? ______
List school(s) where you have applied.______
Have you been accepted? ______
______
Student’s Signature Date
- Student Financial Information (To be kept strictly confidential)
Family’s IRS adjusted gross income for 2013: ______
Do you contribute to your family income by paying any of your car, insurance, or personal expenses? ______If yes, how do you contribute and much per year? ______
Do you contribute to your family income in any other manner? ______. If yes, please explain: ______
Indicate the number of individuals (including parents and dependents) in your household. ______
How many of these individuals will be enrolled in college or trade school in the fall 2013 semester? (Including applicant) ______
If you work (outside the home) how many hours per week do you work? ______
What type of work do you do? ______
Who do you work for? ______
How much is your income? ______
List one work reference and telephone number: ______
List any other scholarships, loans or financial aid you have or will apply for and indicate if you have been accepted: ______
______
- Student Activity Information
A. Please list any volunteer, community, and school sponsored activities you participated in during high school: ______
______
B. Write a short 1-2 page essay on a separate sheet of paper addressing the two questions below. Must be completed by the student and attached to the application.
(a) What are your career goals, intended major in college or trade/vocation being pursued?
(b) Describe your commitment to the Rotary motto of ‘Service above Self’ and your involvement in Interact activities. How do you see this experience impacting your future?
C. Is there anything else that you would like for us to know about you? ______
- Counselor/Interact Club Faculty Advisor Provided Information
Student: All information above to be included and given to your Counselor/Interact Faculty Advisor for completion and submittal. The information below is to be filled out and signed only by your Counselor/Interact Faculty Advisor. This application will not be accepted without the required information, validated and signed.
Counselor: Please provide the following information.
Student GPA (adjusted to a 4-point scale): ______Please provide an official transcript with this application.
Indicate if the student’s GPA is weighted for honors or other advanced classes (yes/no). ______
Indicate if the student's GPA has been impacted by a social or personal event (yes/no). If yes, please discuss: ______
______
Interact Club Faculty Advisor: Please give your reasons why this applicant should be chosen:
______
______
______
______
______
______
______
Interact Club Faculty Advisor signature Date
Interact Club Faculty Advisor: The completed application, including essays & transcripts should be mailed to the Willowbrook Rotary Club, Attention: David Thompson, 9717 Cypresswood Dr., Apt. 502, Houston, TX 77070.
Note: All completed scholarship application forms must be received by April 15, 2014.
The Willowbrook Rotary Club will consider all applicants and selection of the recipients is at the sole discretion of the Selection Committee. The Selection Committee will base its decision solely on the responses on the application and the personal interview.
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