Hot Springs National Park Rotary Club Scholarship Application
Deadline: March 1
1. Current Status:
*
Please Select
High School Senior
Returning College Student
2. Name
*
First Name
Last Name
3. Email Address
*
example@example.com
4. Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
5. Phone Number
*
6. Birth Date
*
-
Month
-
Day
Year
7. Number of members in your immediate household: Including yourself, parents, siblings, and children who live with you.
*
One-member household
Two-member household
Three-member household
Four-member household
Five-member household
More than Five
8. Are YOU a Single Parent?
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Yes, I am a single parent
No, I am not a single parent
9. Do you live with a single parent?
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Yes, I live with a single parent
No, my parents are married and live together
10. Number of members in your immediate household that will be attending College in the fall, including yourself.
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One
Two
Three or more
11. Family Income:
*
Under $25,000
$25,000 - $40,000
$40,001 - $60,000
$60,001 - $75,000
$75,001 - $150,000
Over $150,001
12. Name of High School
*
13. Date of Graduation
*
14. Current High School or College GPA
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Above 3.6
3.1 to 3.5
2.6 to 3.0
2.1 to 2.5
Below 2.0
15. College Classification for Fall Semester
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Freshman
Sophomore
Junior
Senior
16. College you plan to attend
*
17. Degree/Program of Study
*
18. Approximate college cost per year (tuition, fees, & books)
*
19. List any source of tuition assistance (financial aid, scholarships, or employer assistance) that you expect to receive:
*
20. Will you be a first-generation college student?
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No
Yes
21. Employment, including homemaker/stay-at-home parent/caregiver (Hours per Week)
*
Unemployed
Summer Employment Only
0-15 Hours
16-35 Hours
36+ Hours
22. List last 3 employment positions held and dates held (including current position):
*
23. List any offices and positions of leadership held:
*
24. List volunteer/community/family activities in which you have participated:
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25. List any achievements/honors that you have received while in high school or college:
*
26. If you have a parent or grandparent that is an active member of HSNP Rotary Club, please provide their name.
Educational Objective/ Personal Essay - List your educational plans, career plans, and future goals.
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0/500
Letters of Recommendation – Attach two letters of recommendation: One from a teacher (not a counselor, principal, or other administrator). One from a responsible adult (not an educator or relative) who can speak to your character, maturity, and financial need, such as an employer, minister, or family friend. Letters must be current and signed by the person writing the letter.
*
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Transcript - Attach a copy of your high school or college transcript.
*
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Statement of Intent- I certify that I have read and understand the guidelines contained herein. I attest that all information I have provided in this application is true.
*
Date
*
/
Month
/
Day
Year
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