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2012 ST. PETERS ROTARY
SCHOLARSHIP APPLICATION
Dear Applicant,
The St. Peters Rotary Club is pleased to consider you for a scholarship in the amount of $500.00. The St. Peters Rotary Club each year offers up to seven scholarships to local students. Yearly scholarships include:
1. One $500.00 scholarship for a traditional student starting at St. Charles Community College.
2. One $500.00 scholarship for a non-traditional student starting at St. Charles Community College. (A non-traditional student is considered to be someone that has graduated high school and has been away from school for awhile and is now entering college.
NOTE: St. Charles Community College (SCC) applicants will not use the below form. A SCC application can be retrieved from the SCC website. SCC applicants will follow the instructions on the SCC form. The below instructions are for applicants applying directly to the St. Peters Rotary Club for a scholarship to any college or university other than SCC.
3. Multiple (currently as many as five) $500.00 scholarships for seniors that are entering an accredited college or university.
To be eligible, you must meet the following conditions:
1. Live within St. Charles County.
2. Have a GPA of 3.0 or above.
3. Have been accepted (or applied) to an accredited college or university.
Your application will be evaluated by the scholarship committee based on the following criteria.
1. Academic Merit
2. Leadership abilities demonstrated through projects at school, church, sports or community involvement.
3. Hand written essay (Explained below)
4. Financial need
Essay Topic and Instructions:
Please provide on a separate sheet of paper, in your own handwriting, your thoughts on the topic “How I plan to serve my community.” The essay will be evaluated on the basis of structure, grammar, spelling and the clarity of your points by the scholarship committee. The essay should be between one to two pages long. Do not write your name of the essay. It will be assigned the same number by the committee as the rest of the application.
Mail your completed application to:
The Health Centers
Dr. Paul Spahn – Rotary Scholarship Chairman
2621 Raymond Dr.
St. Charles, Mo 63301
The deadline for scholarship applications that can be used for any college or university is April 2, 2012. The deadline for scholarship applications for St. Charles Community College is listed on the SCC website.
The successful scholarship recipients will be notified after the committee makes its decision. Successful applicants will be invited to a St. Peters Rotary Club meeting.
Myself and the members of the St. Peters Rotary Club wish you continued success in your academic endeavors. For more information about the St. Peters Rotary Club, please visit our website at: www.stpetersrotary.org
Best Regards,
Paul R. Spahn, DC, CCSP, CSCS
Scholarship Chairman
2012 ST. PETERS ROTARY SCHOLARSHIP APPLICATION
Applications will be accepted from 1/31/12 to the deadline date of 4/2/12 for the five $500 general scholarships. This is the form for the general scholarships. If you wish to apply for the St. Charles Community College (SCC) scholarship, applicants must use SCC application obtainable from the SCC website or from St. Charles Community College.
NOTE: All of the following information will be used to evaluate the relative merits of the applicant with respect to the St. Peters Rotary Scholarship by our scholarship committee. Please type or print the following information.
Read and follow application instructions closely! How well you follow directions will be considered. Be sure all information is supplied by the deadline. The committee members will not see page 3 during the initial evaluation process. Do not write your name or family member names on pages 4, 5, 6 or the essay! Be sure to attach the essay.
STUDENT INFORMATION:
Name: ___________________________________ Home Phone: ________________________
Address: _________________________________ Cell Phone: __________________________
City: ____________________________________ State: _______Zip: ____________________
Currently Attending Classes at which High School? ____________________________________
Anticipated date of graduation from High School? _____________________________________
PARENT’S INFORMATION:
Father’s Name: ________________________Employer’s Name: _________________________
Mother’s Name: _______________________Employer’s Name: _________________________
ATTESTATION:
By signing below, I attest that all of the information listed above and on the following pages, along with the attached pages of this application is accurate. I am acknowledging and agreeing to the use of the applicant’s name and information in relationship to news releases or information about the St. Peters Rotary Scholarship program.
Student’s Signature: __________________________ Date: ___________________
Parent’s Signature: ___________________________ Date: ___________________
IMPORTANT NOTE:
The following application pages will be available to the scholarship committee members. The scholarship committee will review each application and will not know the identities of the applicants applying. Your application will be assigned a number.
For this reason, it is important that you do not write your name or other family member names on the following pages of the application, the essay or sheets you attach! Be sure all of the pages of the application are sent together at the same time inside one envelop.
List all High Schools you have attended with the most recent first.
School Name: ____________________________________ Dates attended: _________________
School Address, City, State & Zip: _________________________________________________
School Name: ____________________________________ Dates attended: _________________
School Address, City, State & Zip: _________________________________________________
What College or University do you wish to attend?
1st Choice: ____________________________________________________________________
2nd Choice: ____________________________________________________________________
Indicate if you have already applied. (Circle One) Yes No
Indicate if you have been accepted. (Circle Answers)
First Choice: Yes No Pending Second Choice: Yes No Pending
What is your intended Major(s)? _____________________________________________________
What Scholarships have you been informed you will receive? Use additional paper if needed.
Name: ________________________________________________Amount: $_______________
Name: ________________________________________________Amount: $_______________
Name: ________________________________________________Amount: $_______________
Name: ________________________________________________Amount: $_______________
What other scholarships have you applied for and the amounts? Use additional paper if needed.
Name: _________________________________________________Amount: $______________
Name: _________________________________________________Amount: $______________
Name: _________________________________________________Amount: $______________
Name: _________________________________________________Amount: $______________
Name: _________________________________________________Amount: $______________
List clubs, organizational activities, sports, church, community service and any special honors received in high school or within the community with applicable dates. (Attach additional sheets if needed.)
COUNSELOR CERTIFICATION: (To be filled out by school counselor)
ACT Score: ____________ GPA: ______________
Please attach a sealed copy of the student’s transcripts. It must include first semester of the senior year.
Counselor’s signature: ___________________________ Date: ________________________
Counselor’s name (Please print):__________________________Telephone #:____________________
PARENT’S FINANCIAL INFORMATION:
Father’s Occupation: ______________________Mother’s Occupation: ____________________
Please note any unusual expenses, financial situations or loses that has affected your family.
Please furnish information on all dependent children. Scholarship applicant’s information should be listed on the first line.
Age Grade School % Support by family
Scholarship Applicant:
Sibling: (circle one) M F
Sibling: M F
Sibling: M F
Sibling: M F
Sibling: M F
(Attach additional paper if necessary for the above question.)
List the expected expenses for freshman year in College.
Tuition: $_____________________ Room & Board $___________________
Books $______________________
Mail the completed St. Peters Rotary Scholarship Application and essay to:
The Health Centers
Dr. Paul Spahn – Rotary Scholarship Chairman
2621 Raymond Dr.
St. Charles, Mo 63301
Rotary Scholarship Form 1/12