Application For "Service Above Self" Scholarship Award
All information provided on this form will be used solely by the Rotary Club of Coral Springs-Parkland in determining scholarship awards for the 2021 year and will be held in the strictest confidence.
High School Attending:
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Please Select
Coral Glades
Coral Springs
Coral Springs Charter
JP Taravella
Marjory Stoneman Douglas
Basic Information
Full Name
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First Name
Middle Name
Last Name
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Email
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Confirmation Email
Confirm Email
Cell Phone Number
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Alternate Phone Number
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Personal Information
Are you a U.S. Citizen?
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Please Select
Yes, I am a U.S. Citizen
No, but I am a Permanent Resident
No. I am a noncitizen
City and State of Birth
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Parents Information:
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Student Resides With:
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Please Select
Father & Mother
Father
Mother
Other
If Other, please specify Guardian:
Household Size
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Please Select
1
2
3
4
5
More than 5
Only include family members your parent(s) are supporting financially.
Academic Information
Cumulative GPA (Unweighted)
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Cumulative GPA (Weighted)
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Have you taken the SATs?
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Please Select
Yes
No
Will be taking
Test Scores
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Have you taken the ACTs?
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Please Select
Yes
No
Will be taking
Test Scores
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Have you taken/completed any college level courses? (AP, BCC, etc.)
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Yes
No
If yes, describe:
What are your plans after high school?
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Please Select
Attend a 4 year university & earn a bachelor's degree
Attend a 2 year college & transfer to a 4 year university
Attend a 2 year college & earn an associate degree
Attend a trade school & then become employed
Enlist in the military
Become employed full-time
Colleges/Universities to which you have or will be applying
List schools in order of preference.
First Choice
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Second Choice
Third Choice
Fourth Choice
Have you received any acceptances?
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Yes
No
If yes, please specify which ones:
Majors you are Considering
List majors in order of preference.
Major 1
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Major 2
Major 3
What is the decision for choosing your major(s)?
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Activities & Experiences
Did you participate in school activities/clubs?
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Yes
No
Did you participate in sports?
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Yes
No
Did you participate in community service or volunteering activities?
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Yes
No
Do you have any interests or hobbies?
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Yes
No
School Activities/Clubs
List school activities/clubs you have participated while attending high school.
School Activities/Clubs
Name of Activity, Office held, Grade level
Sport Participation
List sports you have participated while attending high school.
Sport Participation
Name of Sport, Sport level, Grade level
Community Services and/or Volunteering Activities
List community services and/or volunteering you have participated while attending high school.
Community Service/Volunteering
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Name of organization, # of hours volunteered, Duties
Total number of service hours to date?
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Are you a member of the Interact Club?
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Yes
No
What, if any, Community Service or Volunteering do you plan on participating in while you are in college?
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Examples: Tutoring, Food Drives, Join Rotaract Club, Non-Profit Organization, etc.
Essay
Required
In 500 words or less, please write about a person, experience or event related to your VOLUNTEER activity that has left the greatest impression on you.
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Interests and/or Hobbies
Please list all of your interests and/or hobbies that you are currently active in.
Examples: Dancing, Music, Art, Stamp Collecting, Gaming, Woodworking, etc.
Financial Information
Household Income is under:
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Please Select
$25,000
$40,000
$60,000
$80,000
$100,000
Select your parents' adjusted gross income for the previous year.
Approximately how much will parents contribute to your college expenses?
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Do you have a Florida Pre-Paid College Plan?
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Yes
No
Have you received or will you receive any other scholarship awards? If so, what are they?
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Examples: College or University Scholarship, Athletic Scholarship, Organization Award, etc.
Are there any special circumstances that may make you eligible for a scholarship?
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Examples: Overcoming obstacles, AB540 student, ineligible for State & Federal financial aid, disabled sibling or parent.
"Laughter is the shortest distance between two people."
~Victor Borge~
To help us know you better, please tell us your favorite joke.
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Additional Information
Please use the space below if there is any other information or circumstances that you feel is important for us to know about you. All information will be held in the strictest confidence.
Signature
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