The Rotary Club of ArlingtonSunrise

Scholarship Application for the 2015 Graduates

Background

These Scholarships are offered by the Rotary Club of Arlington-Sunrise.

Regulations

  1. The Scholarships shall be known as the Rotary Club of Arlington-Sunrise Scholarships.
  1. The Scholarships will be awarded on a competitive basis to Scholars currently in high school. The scholarship committee’s decisions are final.
  1. The scholar will be required to enroll as a full-time Scholar in an undergraduate degree program for the full academic year for which the Scholarship is awarded. The scholar will be enrolled for the first time in 2015.
  1. Scholars must be a Texas resident and must be prepared to present a valid social security card.
  1. The Scholarship will have a value of $2,500 and is tenable for one year.
  1. Scholars who elect to attend Tarrant County College may be eligible for a matching scholarship for the second year at TCC through the Tarrant County College Foundation in the amount of $1,500.
  1. The Scholarship is required to be repaid in full should theScholar withdraw duringthe academic year.
  1. The Scholarship may be held in conjunction with other scholarship awards.
  1. Eligible candidates mustapply for this Scholarship using theattached form.
  1. Only scholarship recipients will be formally advised that they have been awarded a Scholarship.
  1. Family members of Rotarians are ineligible.
  1. Candidates maybe interviewed by the scholarship committee.
  1. For further inquiries, please contact the Rotary Club of Arlington Sunrise:

Telephone:(817) 633-1645

Application Form

This application must be submitted to:Arlington Sunrise Rotary Club

Attn: Scholarship Committee

PO Box 387

Arlington, TX 76004

Applications must be postmarked on or before Wednesday, March4, 2015

Inquiries can be directed to:(817) 633-1645

Please ensure that all questions are answered and that all the required attachments accompany this application form. You may jeopardize your chances of success if you do not complete your application properly.

When preparing your application form and attachments, please DO NOTfold, use staples, special binding, colored paper or colored ink. Please use paper clips, to fasten documents together. Please use as a single sided document. All documents may be photocopied.

Your Personal Details

NAME

Last Name:First Name:

Age at Graduation:

ADDRESS (for correspondence regarding this application)

Street:

City:State:Zip:

Home Phone:Cell Phone:

Email Address:

Facebook Name:MySpace URL:

Employers of parents/legal guardians:


APPLICATION DETAILS

HIGH SCHOOL

School:City:Years:

Grade Point Average:(On a 4.0 scale)ACT score:SAT score:

Academic Counselor: Phone Number:

STUDY INTENTIONS

Please indicate where you plan to enroll for your higher level education

School/Facility:

Planned field of study:

Estimate first year tuition cost:

______

How are you planning to pay for college? (You may attach an additional page if needed.)

______

Parents Details

FATHER’S NAME

Last Name:First Name:

Date of Birth:

Employer:

Job Title: .

MOTHER’S NAME

Last Name:First Name:

Date of Birth:

Employer:

Job Title: .

HouseholdIncomeRange:

[ ] $30,000 and below [ ] $30,001 - $50,000 [ ] $50,001 – $80,000 [ ] $80,001 - $110,000 [ ] $110,001 and above

Are either of your parents members of a Rotary Club? [ ] Yes [ ] No

If yes, Club name and location: ______

Are you a recipient of the Arlington Web Elementary Scholarship program? [ ] Yes [ ] No

NUMBER OF SIBLINGS AND AGES: ______

______

HOW MANY SIBLINGS ARE IN COLLEGE? ______

WHAT SCHOOL ARE THEY ATTENDING? ______

MISCELLANEOUS – (You may attach an additional page if needed.)

What are your educational and professional goals and objectives?

List your academic honors, awards, and membership activities while in high school, noting especially any participation in the Rotary Youth Leadership Award Training (RYLA), the Rotary 4-Way Speech Contest, and Rotaract:

List your community service activities, hobbies, outside interests, extracurricular activities, and anything else that you think might influence our decision:

WORK EXPERIENCE: – (You may attach an additional page if needed.)

List your work experience stating the place of employment, the employer, and your position. Begin list with your current job.

______

ADDITIONAL SCHOLARSHIP RECEIVED

Please list any scholarship that you have received,or that you expect to receive and the amount awarded.

______
ATTACHMENTS

Please attach the following to your application form

Resume

Two reference letters.

Most recent official high school transcript.

STATEMENT OF ACCURACY

I hereby affirm that all the above stated information provided by me is true and correct to the best of my knowledge. I also consent that my picture be taken and used for any purpose deemed necessary to promote the scholarship program.

I hereby understand that if chosen as a scholarship winner, according to the Rotary Club of Arlington-Sunrise Scholarship policy, I must be present at the awards ceremony/reception to receive my scholarship award.

Signature of scholarship applicant:Date:

Applications must be postmarked on or before Wednesday, March 4, 2015

No Exceptions!

CONDITIONS

I understand that:

1. If I am offered the Scholarship, and I accept it, I will only be eligible to be formally awarded the Scholarship if I am enrolled in higher education in the year of tenure and I comply with any other specific requirements of the award.

2. The Scholarship Committee may terminate a Scholarship at any time and recoup any funds awarded if it is satisfied that the holder is not following the requirements or is not complying with the conditions governing the Scholarship.

PRIVACY DECLARATION

The information requested in the attached application form will be used solely for the purposes of assessing your Scholarship application. Personal information contained in this application will be made available to members of the Scholarship Committee.

The Rotary Club of Arlington-Sunrise undertakes to store your application in a secure place in the event that you are awarded a scholarship or are selected as a reserve candidate for a scholarship. The Rotary Club of Arlington-Sunrise undertakes to destroy your application to preserve its confidentiality if you are not awarded a scholarship. Should you have reason to believe that information held about you in either your application or your academic record is incorrect, you have the right of access to and correction of that information if you request permission to amend your application in writing prior to the application deadline of March 4, 2015.

SIGN HERE

Signature:Date:

Applications must be postmarked on or before Wednesday, March 4, 2015

Return all applications to:

ArlingtonSunrise Rotary Club

Attn: Scholarship Committee

PO Box 387

Arlington, TX 76004

1