ORLAND PARK ROTARY CLUB

C CAREER SCHOLARSHIP APPLICATION - 2016

INSTRUCTIONS

TO THE APPLICANT: On a separate sheet of paper, please provide necessary information and answer the following questions. Then return the application to your school’s guidance office by March 4,2016. No action will be taken on applications filled out after this date. Applications will not be accepted unless processed through the school’s guidance office.This information is only to be used by the scholarship committee and, as such, is confidential. Also, please have two reference forms (see next page), one from a teacher and one from someone who knows of your community service, sent directlyto: Orland Park Rotary Scholarship, c/o Dr. James Gay, 15100 S. 94th Ave., Orland Park, Il. 60462 by

March 11, 2016.

Start the application (separate sheet of paper) with these words: CAREER SCHOLARSHIP APPLICATION

1.Name

Address, City, State, Zip

Home Telephone Number

E-mail Address

Date of Birth

Sex

High School

2.What is your Grade Point Average for 7 semesters?

3.List the student activities in which you actively participate or have participated in high school. Indicate the number of years in each activity.

4.What special recognition in the form of offices held, awards or honors did you receive from participation in these activities (refer #3).

5.In what community activities—both work and service—have you participated? How many hours of community service have you provided during the last 7 semesters?

6. Discuss any family circumstances which may have limited your ability to participate in student activities or community service.

7.What post-secondary institution do you plan to attend? Have you applied and been accepted?

8.What will be your career focus?

9.How have you spent your last two summer vacations?

10.Essay: In 300 to 500 words, describe your future plans, how your high school years have shaped those plans, and how your future plans reflect Rotary’s goals (see to understand the goals of Rotary).

11.Sign and date your application. Return the application to the school’s guidance office by March 4, 2016.


ORLAND PARK ROTARY CLUB

CAREER SCHOLARSHIP REFERENCE FORM - 2016

I hereby waive my right to access this recommendation on behalf of my application to the Orland Park Scholarship program. This waiver is effective insofar as the recommendation is used solely for the purpose of the scholarship award program.
Printed Name: ______Date:______Signature:______

Reference Form

1. Name of Candidate: ______HIGH SCHOOL______

2. How long have you known him/her and in what capacity?

______

______
3. Please comment briefly on the candidate's potential for college study:

4. Please comment briefly on the candidate’s commitment to service:

5. Additional Comments:

Your printed name:______Role:______

Signature:______Date:______

Do not return this completed form to the student, but send directly to Orland Park
Rotary Scholarship, c/o Dr. James Gay, 15100 S. 94th Ave., Orland Park, Il. 60462.
Please returnthis form by March 11, 2016.