BEVERLY ROTARY CLUB FOUNDATION

BEVERLY ROTARY CLUB FOUNDATION

JACK GOOD SCHOLARSHIP APPLICATION 2024
PERSONAL INFORMATION
Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Phone Number
E-mail
Enter E-mail Here
Address

Street Address

Apt/Unit #

CityState

Zip Code
Do you reside in Beverly, MA?
Residency in Beverly, MA is a requirement for eligibility
EDUCATIONAL BACKGROUND
1- Do you have a high school diploma or high school equivalency certificate (this is a requirement for eligibility)?

YesNo
If yes, please provide the following:
Name of High School or Institution:
Year of Graduation or Completion
Attach a copy of your diploma or equivalency certificate:

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2- Do you have an associate's or bachelor's degree?

YesNo
If yes, please provide the following:
Name(s) of Institutions:
Year(s) of Graduation or Completion:
Degree Obtained:

If yes, please attach proof of application or acceptance:

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Please also attach documentation of the details of the course you are requesting financial assistance with (such as the catalog listing which includes institution, course description, date and cost):

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If no- please explain your timeline for applying.
EMPLOYMENT AND EXPERIENCE
1- Current Occupation (if available):
Job Title:
Employer:
2- Briefly describe your prior work, education and/or community activities (300 words max):

0/300
LETTERS OF RECOMMENDATION/SUPPORT
Please submit two letters of recommendation or support from individuals who are familiar with your circumstances, prior work, education and community activities.
Recommender 1:
Name

First NameLast Name
Relationship to Applicant:
Email
example@example.com
Phone Number
Please enter a valid phone number.
Letter of Recommendation- 1

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Recommender 2:
Name

First NameLast Name
Relationship to Applicant:
Email
example@example.com
Phone Number
Please enter a valid phone number.
Letter of Recommendation- 2

Cancelof

FINANCIAL NEED
1- Please provide a statement of financial need (300 words maximum). Describe your current financial situation, including any financial challenges that may impact your ability to attend this program.

Explain why you are seeking financial assistance and how receiving this scholarship would help you achieve your educational goals.
Statement of Financial Need:

0/300
2- Do you have any other sources of financial assistance (scholarships, loans, etc) for this program?

YesNo
If yes, please provide details about the funding sources and amounts.

PERSONAL STATEMENT
In 500 words or less, describe your personal story, including why you are applying for this scholarship, how this scholarship will impact your future educational goals, and any challenges you have overcome as a nontraditional student:

0/500
SUBMISSION INSTRUCTIONS
Please make sure you submit a completed application form with the following:
1. Copy of your high school diploma/equivalency certificate
2. Two letters of recommendation/support
3. Statement of financial need
4. Proof of application or acceptance (if available)
5. Documentation of the details of the course you are requesting financial assistance with (such as the catalog listing which includes institution, course description, date and cost)
If filling this form via PDF and not online, please do make sure to attach these items to your email or in your form package.

Please note that applications that are incomplete or missing may not be considered. The deadline for applications is: NOVEMBER 18, 2024

If you have questions about the application form or scholarship, please reach out to:

Lori Cianculli- Beverly Rotary Club Scholarship Chair

Email Address: lac@candolawyers.com

Mailing Address: 163 Cabot Street, Beverly MA 01915

Phone: 978-922-9933
APPLICANT CERTIFICATION
I hereby certify that all the information provided in this applicaton is true and accurate to the best of my knowledge.
Signature (typed if electronic):

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PERSONAL INFORMATION