Scholarship Application
Victoria Rotary Club
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth
*
-
Month
-
Day
Year
Date
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Alternate Phone Number
Please enter a valid phone number.
Number of family members living at home, including yourself:
*
Number of immediate family members, including yourself, who will be attending college next year:
*
Your High School
*
GPA
*
Rank
*
Name of college/university you plan to attend
*
Have you been accepted to the college/university above?
*
Yes
No
Pending
College major or Career Goal
*
Provide college assessment test scores by listing the test name, test date, and score (for instance: SAT, December 2021, 1100). College assessments include ACT, SAT, TSIA.
Provide your activities list, including any community service, employment, awards, extracurricular activities, church involvement, interests, hobbies, leadership experiences, etc.
If you participated in the Rotary Early Act First Knight (EAFK) Program, please list: your elementary school, year(s), and for which virtues you were knighted.
Explain any special circumstances of extraordinary expenses (i.e. divorce, parenthood, unemployment) that you would like to have considered.
I hereby certify that the information presented in this application is accurate to the best of my knowledge and understand that my scholarship application will be reviewed once applicant information and scholarship requirements are fulfilled.
*
Date of Application
*
-
Month
-
Day
Year
Date
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