High School Scholarship Application Form

Rotary Club of Williamsburg High School Scholarship Application (2026)

The Rotary Club of Williamsburg awards a $1,000 scholarship to students currently enrolled at one of the Williamsburg/James City County/Bruton District of York County public or private high schools. Please fill out this application completely as incomplete applications will not be considered for a scholarship. Deadline for application submission is May 31. If you have any questions regarding your application, please send an email to jcmiles7@gmail.com.
BASIC INFORMATION
Student's Full / Legal Name*

First NameMiddle NameLast Name
Student Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Student Phone Number*

Area CodePhone Number
Student E-mail*
Student Birth Date

MonthDayYear
Gender

REFERENCES:

Please list one educator and one community person who would recommend you for a scholarship.
Reference 1 Name (Position, Phone Number, Email Address)
Reference 2 Name (Position, Phone Number, Email Address)
SCHOOL / COMMUNITY ACTIVITIES / WORK EXPERIENCE / SPORTS/AWARDS / ETC:

List name of school club(s) and years of participation. If you volunteered, list the name of the organization(s) and the approximate number of hours and weeks of your volunteered time. If you worked, list the company, hours per week and length of time. Attach an additional sheet or resume if necessary.
School Activities / Offices Held: (not sports)
School Activities / Offices Held: (not sports)
School Activities / Offices Held: (not sports)
School Activities / Offices Held: (not sports)
Community Service / Volunteer Activities (outside of school)

A Short Essay (250 - 300 words) is required. Please choose from one of the following topics: 1. What do you consider to be the single most important issue facing college students today? Explain? 2. Describe an example in which you have demonstrated leadership ability inside or outside of school. What impact did it have on others well as yourself? 3. Tell us about a decision you've made that has had consequences (good or bad) for yourself or others.*

Father/Stepfather/Guardian Name
Father/Stepfather Employer and Occupation
Mother/Stepmother/Guardian Name
Mother/Stepmother Employer and Occupation:
Number of dependents in home (including yourself):
Are you the first generation in your family to attend college?

YesNo
Please explain any unusual circumstances such as, child-support ending, emergency expenses, medical bills, seasonal work, unemployment, which might impact funding for your college education and that should be taken into account in considering your application.

Please Note:

By completing this application, you acknowledge and agree that not all applicants will receive a scholarship and that the Scholarship Committee at its sole discretion reserves the right to decide which individual(s) will or will not receive scholarships; said decisions being final. All information submitted will be held in the strictest confidence.
Submission Time

MonthDayYearHourMinutesAM/PM Option
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Rotary Club of Williamsburg High School Scholarship Application (2026)