Freeport Lincoln-Douglas Kiwanis Club

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FREEPORT LINCOLN-DOUGLAS KIWANIS CLUB

YOUTH SERVICES SCHOLARSHIP AWARD APPLICATION FORM

STUDENT NAME:______PHONE:______

Last First Middle Initial

PARENT(S) NAME::______

STREET ADDRESS:______

CITY, STATE, ZIP CODE:______

SCHOOL:______CHURCH:______

ACT Score ______SAT Score ______GPA ______

Kiwanis International is concerned about their communities and the world. We of the Freeport Lincoln-Douglas Kiwanis Club want to reward Stephenson County, Illinois High School senior(s) who are actively involved in service to our community. Our scholarships, of up to $1,000.00 per scholarship, can be applied toward any post-secondary educational expenses. The scholarships are based on academic achievement, community service and financial needs. Keep in mind that the Youth Services Scholarship Committee will be looking for applicants that demonstrated leadership skills, a willingness to serve and community involvement through out their high school careers and are planning to continue in this manner in the future.

To apply, please answer the questions below and return this form, one reference letter as listed in question #6 and your high school transcript to:

Kristen Woitynek, 28 N Harlem Ave.,Freeport, IL 61032 by March 31, 2018. All scholarships must be postmarked by March 31, 2018. NO hand delivered scholarships, please. The scholarship recipient(s) will be notified inMay, 2018.

Please, use the form provided and keep attachments to a minimum.

*Note: Please do not use names or references to the high school you attend on the application form.

*All information you provide on this application will be kept confidential.

The Freeport Lincoln-Douglas Kiwanis Club would like to thank all applicants for applying. Best wishes with your educational pursuits.

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SAT______

GPA______

FREEPORT LINCOLN-DOUGLAS KIWANIS CLUB

YOUTH SERVICES SCHOLARSHIP AWARD APPLICATION FORM

1.What are your future plans and goals? What college and your anticipated major?

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2.SCHOOL ACTIVITIES - List your school activities, accomplishments and awards in the following schedule. Also include a copy of your most recent grade transcript.

DATEACTIVITY OR AWARD ACCOMPLISHMENT

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3.COMMUNITY INVOLVEMENT - List your involvement in projects or groups that work for the betterment of Stephenson County, Illinois or larger regional or national activities.

DATEACTIVITY GOAL OF PROJECT

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FREEPORT LINCOLN-DOUGLAS KIWANIS CLUB

YOUTH SERVICES SCHOLARSHIP AWARD APPLICATION FORM, continued

4.FINANCIAL INFORMATION - Please answer the following:

a. If you work, what did you earn in 2017? ______

b.Your family annual income: ______& number of people living in household ______

c. Do you have any other family members in school or college? Yes No

If yes, who and at what level of school?

*Note - Do not use names only parent, brother or sister and current grade level

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d.List other scholarships or grants you have applied for or have been awarded:

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e.List any part-time or full-time jobs you have:

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f.What is your financial need? Are your parents paying for your college education? What percentage of your college expenses do you have to pay on your own? From what sources, if any, will the additional expenses come from?

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5.In fifty words or less, explain why you feel you should be awarded this scholarship:

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6.Please provide a letter of reference from one of the following (one reference letter is required in order to be considered by the scholarship committee):

a.School

b.Community

c.Other