Clone of 2026 Optimist Club Academic Scholarship Grant

Waterloo Optimist Club - Academic Scholarship ($1,000.00) Application Form

Application Deadline - Friday, April 10, 2026, 3:00PM
Read and follow the instructions carefully prior to submitting your application.

Please complete the following application.

Complete all entries of online form, and PRINT the application for submission. Attach the following documentation to the application:
1. Verification of admission for the next academic year
2. Transcript of High School Grades
3. Letter of Acceptance from institution of higher learning
4. Letter of recommendation (one only) from principal, counselor, department head, or homeschool instructor.
5. Personal letter from applicant setting forth reasons you are applying and your future plans.
NOTE: Children of Waterloo Optimist Members are not elligible for this grant.

This scholarship is open to students of Waterloo High School, Gibault High School, and homeschool students residing in the Waterloo School District only.

Submit the completed application with all documents specified to your High School Counselor's Office no later than Friday, April 10, 2026, at 3:00 PM. Homeschooled applicatants shall submit the completed application with all documents to Roger Osterhage, 200 Adams Drive, Waterloo, IL 62298 or rosterhage53@gmail.com no later than Friday, April 10, 2026 at 3:00 PM.
Read and Understand the instructions.*

Yes, I have
A: PERSONAL INFORMATION
Full Name*

PrefixFirst NameMiddle NameLast NameSuffix
Birthdate (Month/Day/Year)
Phone*

Area CodePhone Number
E-mail :*
Where the confirmation will be send to
Home Address :*

Street Address

Street Address Line 2

CityState

Zip Code
Gender:

MaleFemale
B: SCHOOL ATTENDANCE
1: High School Attended:
Dates Attended:
High School Attended:
Dates Attended:
High School Attended:
Dates Attended:
STANDARDIZED TEST SCORES
ACT Score
SAT Score
2: Credits Recieved From Institutions Of Higher Learning:
Classes Taken
Dates
Credits Earned
Classes Taken
Dates
Credits Earned
Classes Taken
Dates
Credits Earned
3: Name Of Institution To Which Scholarship Will Be Applied:
Course Of Learning To Be Pursued
C: PARENTS (or guardian): (NOTE: The only persons having access to this information are of the selection committee. Applications are destroyed after the selection process.)
Father's Name:
Occupation:
Mother's Name:
Occupation:
1. Family Income Range

Less Than $50,000$50,000 - 100,000Over $100,000
2. Do your parents claim you as a dependent for tax purposes?

YesNo
3. Total number of dependents in household including you?
4. If your parents DO NOT CLAIM you as a dependent, please explain:
D: SCHOLARSHIPS
1. Have you applied for any other scholarships?

YesNo
2. Do you hold any rights to a scholarship now?

YesNo
If yes, please explain:
E: FINANCIAL AID:
Have you received, or have you applied for financial assistance to pursue your course of study?

YesNo
If yes, please explain:
F: AWARDS
1. List any Optimist or other community-related service awards you have received:
2. List any Academic awards or honors you have received:
G: EXTRA-CURRICULAR ACTIVITIES
List any extra-curricular activities: (I.E. Band- 3 yrs., Football-2 yrs., Captain Football Team, etc.)
Mailing Address:
H: PERSONAL REFERENCES (2)
Full Name / Phone:
Mailing Address:
Full Name / Phone:
Mailing Address:
I HEREBY CERTIFY THAT THE STATEMENTS HEREIN MADE BY ME ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. I HAVE ATTACHED THE FOLLOWING DOCUMENTS KNOWING THAT SHOULD ANY BE OMITTED, MY APPLICATION IS INCOMPLETE AND WILL, THEREFORE, NOT BE CONSIDERED FOR SCHOLARSHIP GRANT.
HEREBY SUBMITTED WITH THIS APPLICATION ARE THE FOLLOWING:*

Transcript Of GradesVerification Of AdmissionLetter Of RecommendationPersonal Letter
By signing (typing your legal name) in the space below, you are certifying that all information is correct and that you are the person completing this application. Please print for your records and retain as verification of your application.
E-Signature:*
NOTE: IF PRINTING FORM, PLEASE CLICK PRINT BUTTON FIRST

**BEFORE**

CLICKING SUBMIT BUTTON!
Should be Empty:

Waterloo Optimist Club - Academic Scholarship ($1,000.00) Application Form