Seattle International District Rotary Club

SEATTLE INTERNATIONAL DISTRICT ROTARY CLUB

2012-2013 SCHOLARSHIP/VOCATIONAL FINANCIAL ASSISTANCE APPLICATION

for the

Zahir Ahmed Scholarship, Phil Gai Scholarship, Lloyd Barnes Scholarship, and Charles Peterson Scholarship

Recipients for financial assistance will be selected based on their academic achievement, community/volunteer involvement and financial need.

NAME:
STREET ADDRESS:
CITY, ZIP:
TELEPHONE (HOME): / TELEPHONE (WORK):
EMAIL ADDRESS:
CURRENT SCHOOL: / YEAR IN SCHOOL:
SCHOOL(S) APPLIED TO FOR THE 2013-2014 ACADEMIC YEAR:
ACCEPTED? / NAME / CITY / STATE
LIST HONORS AND/OR AWARDS YOU HAVE RECEIVED DURING YOUR HIGH SCHOOL YEARS. Use another page if needed.
DESCRIBE YOUR INVOLVEMENT IN AND SERVICE TO YOUR COMMUNITY, INCLUDING VOLUNTEER ACTIVITES. Use another page if needed.

Rotary International has a 4 Way Test to encourage its members to follow in their professional and personal lives. It reads: 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? On a separate piece of paper(in 300 words or less), please write how you would apply this 4 Way Test to your post-high school educational endeavors.

TYPE OF FINANCIAL ASSISTANCE: ____SCHOLARSHIP ____VOCATIONAL

ON A SEPARATE PIECE OF PAPER, PLEASE LET US KNOW YOUR PERSONAL, EDUCATIONAL/VOCATIONAL AND/OR CAREER GOALS.

FINANCIAL INFORMATION:
Is your family’s income below or above $54,600 annually? / Below / Number of persons in household:
Above
Have you applied for financial aid? / Yes ___ No ___ / Amount Granted:
Have you applied for and received other scholarships? / Applied: / Yes / No
Received: / Yes / No
If you have received other scholarships, please list the scholarship and the amount:
Describe any circumstances that have an impact on your ability to fund your college education? Use another page if more space is needed.
Please attach:
Letter of recommendation from school counselor, principal or teacher
Official School transcript
4 Way Test application essay
Personal, educational, and/or career goals essay
Additional information you feel may be useful in your application
2” x 3” portrait photo or similar
I certify that the questions have been answered honestly and accurately:
I certify that the person named here filled out this application and attached narratives:
Signature of student: / Date:
Signature of parent: / Date:

Applications MUST be postmarked by January 25, 2013. Mail to:

Paul Mar, Rotary Scholarship Chair

8261 SE 36th St.

Mercer Island, WA 98040