Scholarship Application Form

The Kiwanis New York District Foundation will present at least four (4) scholarships, not to exceed $1,000 each, to graduating high school seniors in 2025.

The following criteria must be met:
1. The applicant will have participated in school and community activities demonstrating outstanding community service.
2. The applicant will have participated in school and community activities demonstrating outstanding leadership.
3. Applicant will have demonstrated academic success.
4. Applicant and/or family have a documented financial need.

Conditions of Eligibility- Applicant must complete the following:
1. Applicant must be nominated by a Kiwanis Club.
2. Submit a written application (see checklist) on or before April 15
3. Funds can only be used for the following college-related expenses: Tuition, room and board, and books.
4. Funds are a one-time award and will be mailed to the College of Acceptance.

Method of Selection:
1. The scholarship award will be made based on community service, leadership activities, academic performance, and/or financial need.
2. The Scholarship Selection Committee will select the winners.
3. The successful applicants will be announced by the committee and will receive the award during an appropriate awards ceremony.

If selected, you will be asked for documentation to support the data you provide. Likewise, all correspondence and award agreements will be generated from the personal information submitted below. So, please use proper spelling, capitalization and punctuation.

Application Date

Date

Full Name*

First NameLast Name

Birthdate*

MonthDayYear

Mobile No*

Email *

Where the confirmation will be send to

Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

High School Attended:

High School Graduation Date:

College to which you have been accepted and are planning to attend:

College Identification Number:

Please provide a college identification number, if available.

Planned academic major and/or future career choice:

Nominated by the Kiwanis Club of:

Club Name

Activities - File Upload

Essay - File Upload

Recommendation Letter - File Upload

Official School Transcript - File Upload

College Acceptance Letter - File Upload

Personal Amount $:
Other Scholarship(s) $:
Student Loan(s) $:
Other Financial Resources $:
TOTAL $:

Other Financial Need Information (optional)

Family Income (include all sources (i.e. father, mother, other providing support)

	$0-$25,000	$25,000-$75,000	$75,000+
Mother
Father
Other
Other
Other
Other
Other

By signing below, you are certifying that all information is correct and that you are the person completing this application. When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your application.

Signature

The Kiwanis New York District Foundation is the charitable funding arm of the New York District of Kiwanis. The foundation, which receives its funding from Kiwanis Clubs, Kiwanians, and special events, supports several ongoing projects and makes specific grants.

Scholarship Application Form

I. Personal Data

Community Service and Leadership

Essay

Recommendation Letters

School Transcript

College Acceptance Letter

Financial Need

Family Income

VIII. Applicant's E-Signature