KIWANIS ENDOWMENT FUND SCHOLARSHIP APPLICATION FORM
Kiwanis Club of Fremont, Ohio, Inc.1409 E. STATE ST., PMB #10, FREMONT, OHIO 43420 OHIO DISTRICT DIVISION 12 ___________________________________________________
KIWANIS ENDOWMENT FUND SCHOLARSHIP APPLICATION FORM PLEASE READ CAREFULLY. PLEASE PRINT OR WRITE CLEARLY.
ELIGIBILITY: High School seniors who are definitely planning to attend college this fall may complete this application form in order to be considered for our scholarship. Four separate scholarships of up to $1,000 will be awarded (the amount may vary depending on funds available). These non-renewable scholarships will be awarded to one student each from Fremont Ross High School, St. Joseph Central Catholic High School, Gibsonburg High School, and Clyde High School. To be eligible, applicants must meet the following basic requirements: 1) Currently attend one of the four schools listed above; 2) Definitely plan to attend college this fall; 3) Have experience in community service and/or volunteer work; 4) Be a current member of your school’s Key Club. Please complete this application form if you meet the above requirements. Return this form to your school’s guidance counselor NO LATER THAN APRIL 15. ********************************************************* APPLICANT INFORMATION: Please answer the following questions as accurately as possible. Any applications proven to have false information will be disqualified and rejected. If you are uncertain how to answer a particular question, feel free to ask your guidance counselor for assistance. NOTE: PLEASE DO NOT PUT YOUR NAME, ADDRESS OR PHONE NUMBER ON PAGES 1-4 (only on page 5) School: _________________________________________
Application Date: ______/______/______
1. Which county do you reside in? ________________________________________________________ 2. Have you performed any community service or volunteer work? Yes_____ No_____If yes, list such activities: _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________
_______________________________________________________________________________ _______________________________________________________________________________ ______________________________________________________________________________ 3. Have you received or do you anticipate receiving any other college scholarships this year? If yes, please list source and amount: _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ 4. When and why did you initially join Key Club? _______________________________________________________________________________ _______________________________________________________________________________ 5. List any officer positions in Key Club which you have held and give the dates: _______________________________________________________________________________ _______________________________________________________________________________ 6. List the Key Club service projects or fundraisers to which you have contributed, and specify the years: _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ 7. To which colleges have you been accepted? _______________________________________________________________________________ Which will you attend? ___________________________________________________________ 8. List all extracurricular activities you have participated in over the past four years and specify the years of involvement: _______________________________________________________________________________ Page 2 of 5
_______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ 9. Have you ever had an after school or weekend job? Yes_____No_____ If yes, describe the job and give the dates of employment: _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ 10. ESSAY QUESTION: In 100 words or less, what do you perceive to be the value of community service organizations such as Kiwanis in contemporary society? _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________
Page 3 of 5
********************************************************* This section is to be completed only by your guidance counselor. 1. What is the above applicant’s class rank? _____________________________________________ 2. What is the above applicant’s grade point average? _____________________________________ 3. Is the above applicant’s grade point average in the top 20% of his or her graduating class? Yes _____ No_____ 4. How many students are expected to graduate from your school this year? ____________________ Counselor’s Signature _________________________________________________________________ ********************************************************* This section is to be completed only by your Key Club Adviser. 1. Has the applicant attended all or most of the Key Club meetings? Yes _____ No _____ 2. Is the applicant active in Key Club? (explain) _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ 3. What did this applicant do special to make them the right choice for this scholarship? _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ Adviser’s Signature: _____________________________________________________________________
Page 4 of 5
********************************************************* CERTIFICATION Please certify that the preceding information is accurate by signing below and have a parent or guardian do the same. Applicant’s signature: __________________________________________________________________ Parent or Guardian’s signature: ___________________________________________________________ Print Applicant’s Name: __________________________________________________________________ Address and Phone Number: ______________________________________________________________
Page 5 of 5
KIWANIS ENDOWMENT FUND SCHOLARSHIP APPLICATION FORM PLEASE READ CAREFULLY. PLEASE PRINT OR WRITE CLEARLY.
ELIGIBILITY: High School seniors who are definitely planning to attend college this fall may complete this application form in order to be considered for our scholarship. Four separate scholarships of up to $1,000 will be awarded (the amount may vary depending on funds available). These non-renewable scholarships will be awarded to one student each from Fremont Ross High School, St. Joseph Central Catholic High School, Gibsonburg High School, and Clyde High School. To be eligible, applicants must meet the following basic requirements: 1) Currently attend one of the four schools listed above; 2) Definitely plan to attend college this fall; 3) Have experience in community service and/or volunteer work; 4) Be a current member of your school’s Key Club. Please complete this application form if you meet the above requirements. Return this form to your school’s guidance counselor NO LATER THAN APRIL 15. ********************************************************* APPLICANT INFORMATION: Please answer the following questions as accurately as possible. Any applications proven to have false information will be disqualified and rejected. If you are uncertain how to answer a particular question, feel free to ask your guidance counselor for assistance. NOTE: PLEASE DO NOT PUT YOUR NAME, ADDRESS OR PHONE NUMBER ON PAGES 1-4 (only on page 5) School: _________________________________________
Application Date: ______/______/______
1. Which county do you reside in? ________________________________________________________ 2. Have you performed any community service or volunteer work? Yes_____ No_____If yes, list such activities: _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________
_______________________________________________________________________________ _______________________________________________________________________________ ______________________________________________________________________________ 3. Have you received or do you anticipate receiving any other college scholarships this year? If yes, please list source and amount: _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ 4. When and why did you initially join Key Club? _______________________________________________________________________________ _______________________________________________________________________________ 5. List any officer positions in Key Club which you have held and give the dates: _______________________________________________________________________________ _______________________________________________________________________________ 6. List the Key Club service projects or fundraisers to which you have contributed, and specify the years: _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ 7. To which colleges have you been accepted? _______________________________________________________________________________ Which will you attend? ___________________________________________________________ 8. List all extracurricular activities you have participated in over the past four years and specify the years of involvement: _______________________________________________________________________________ Page 2 of 5
_______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ 9. Have you ever had an after school or weekend job? Yes_____No_____ If yes, describe the job and give the dates of employment: _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ 10. ESSAY QUESTION: In 100 words or less, what do you perceive to be the value of community service organizations such as Kiwanis in contemporary society? _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________
Page 3 of 5
********************************************************* This section is to be completed only by your guidance counselor. 1. What is the above applicant’s class rank? _____________________________________________ 2. What is the above applicant’s grade point average? _____________________________________ 3. Is the above applicant’s grade point average in the top 20% of his or her graduating class? Yes _____ No_____ 4. How many students are expected to graduate from your school this year? ____________________ Counselor’s Signature _________________________________________________________________ ********************************************************* This section is to be completed only by your Key Club Adviser. 1. Has the applicant attended all or most of the Key Club meetings? Yes _____ No _____ 2. Is the applicant active in Key Club? (explain) _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ 3. What did this applicant do special to make them the right choice for this scholarship? _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ Adviser’s Signature: _____________________________________________________________________
Page 4 of 5
********************************************************* CERTIFICATION Please certify that the preceding information is accurate by signing below and have a parent or guardian do the same. Applicant’s signature: __________________________________________________________________ Parent or Guardian’s signature: ___________________________________________________________ Print Applicant’s Name: __________________________________________________________________ Address and Phone Number: ______________________________________________________________
Page 5 of 5
