Middletown Rotary Scholarship

2009 Middletown Rotary Service Above Self Scholarship Award

Rotary is a worldwide organization of more than 1.2 million business, professional, and community leaders. Members of Rotary clubs, known as Rotarians, provide humanitarian service, encourage high ethical standards in all vocations, and help build goodwill and peace in the world.

There are over 32,000 Rotary clubs in more than 200 countries and geographical areas. Clubs are nonpolitical, nonreligious, and open to all cultures, races, and creeds. The Object of Rotary is to encourage and foster the ideal of service as a basis of worthy enterprise and, in particular, to encourage and foster:  The development of acquaintance as an opportunity for service;

 High ethical standards in business and professions, the recognition of the worthiness of all useful occupations, and the dignifying of each Rotarian's occupation as an opportunity to serve society;

 The application of the ideal of service in each Rotarian's personal, business, and community life;

 The advancement of international understanding, goodwill, and peace through a world fellowship of business and professional persons united in the ideal of service. As signified by the motto Service Above Self, Rotary’s main objective is service — in the community, in the workplace, and throughout the world. Consistent with this the Middletown Rotary Club will award a Service Above Self scholarship(s) to one or two local graduating seniors who meets the following criteria:

 A solid record of demonstrated commitment to the concept of Service Above Self  An academic record of 3.0 gpa and above  Demonstrated financial need as evidenced by a total household family net income of $100,000 or less  The ability to communicate a positive attitude and sincere motivation  Evidence of acceptance to a college and/or university for the ’08 – ’09 academic year

All applications must be turned into your guidance office by April 3rd and delivered to the address below by April 16th. Incomplete applications will not be considered. Three finalists will be selected for interviews. Awards will be made in May 2009.

A complete application will include the attached general information and following materials:  A certified transcript from your high school guidance department giving evidence of a 3.0 gpa  Recommendations from 2 teachers and 1 other adult who can attest to your character  Copies of the most recent tax returns (1040 or 1040EZ) for the applicant and his/her parents  An essay speaking to your experience of Service Above Self and your aspirations for the future

All materials will be held in the strictest confidence.

Completed applications can be mailed or delivered in person to:

Kevin Wilhelm Middletown Rotary Scholarship Committee Chair C/O Middlesex United Way 100 Riverview Center, Suite 230 Middletown, CT 06457

Middletown Rotary Service Above Self Scholarship Award

1 STUDENT’S APPLICATION

GENERAL INFORMATION

Name in Full ______Date of Birth ______(first) (middle initial) (last)

Home Address ______Tel. No. ______(street) (city) (zip)

Father’s Full Name ______Is he living? ______

Father’s Address ______Tel. No. ______

Father’s Occupation ______

Mother’s Name ______Is she living? ______

Mother’s Address, if different ______

Mother’s Occupation ______

Legal Guardian’s Name (if not with parents) ______

Guardian’s Address ______Tel. No. ______

Brothers/Sisters at Home/School: Name Age Grade/Class

School and Community Experience

(Please attach a copy of your school transcript to this application)

What is your favorite school subject? ______Least favorite? ______

What studies have you found most difficult? ______

Please list any honors or prizes received for your academic work. ______

______

2 In what extracurricular school activities have you participated? Please list in order of their importance to you.

No. of No. of Years Years

1. 6. 2. 7. 3. 8. 4. 9. 5. 10.

What leadership roles have you taken in these groups? ______

______.

In what organizations outside of school have you been active? (church, civic groups, etc.) ______

______

______.

What are your general interests or hobbies? ______

______.

Future Plans

Please list in order of preference the vocations you are considering for your life’s work:

1) ______2) ______3) ______

To what colleges or universities are you making application?

1) ______2) ______3) ______

In what field of study do you expect to major?

1) ______2) ______

Please provide us with three letters of reference. Two from teachers and one from an unrelated adult.. They should discuss your qualifications, vocational goals and your character.

On a separate sheet, please write an autobiographical sketch including important events in your life, how “ Service Above Self” describes you and your goals for the future. Your essay should not exceed 300 words.

3 Finances

Do you presently have a job? ______. If yes, what is it? ______

Do you expect to work next summer? ______. During school vacations? ______.

Balance sheet for your freshman year of college Use the cost figures for the school you expect to attend.

Expenses Income

Tuition $ Personal Savings $ Room & Board College Income Other Fees Scholarships* Furnishings Student Loans Books/Supplies Work/Study Clothing/Laundry Other Travel Vacation Employment Entertainment From Parents/Guardians Insurance Other Relatives/Friends Personal Expenses All Other Sources (Itemize) Church/Charity Other (Itemize)

Total: $ Total: $

How many brothers and sisters have preceded you in college? ______.

How many will follow? ______.

*Scholarships - Estimate what you are depending upon from all sources, including Rotary.

4 Are there any special factors which you would like us to know ... other brothers/sisters in school or college, major medical or other expenses of an ongoing nature which might place special hardships on you or your parents/guardians in trying to meet the cost of your education?

______

______.

Applicant’s Signature: ______

Parent/Guardian Signature: ______

Note: Your application must be handed in to your school guidance office by April 3, 2009 and received by us by April 16, 2009. No applications will be accepted after that date and no incompletes applications will be considered.

5 THE MIDDLETOWN ROTARY CLUB SCHOLARSHIP Parent’s Confidential Financial Statement

Date: ______, ______

1. Name of Student ______

2. Parent/Guardian Employment:

Father’s Company ______Position ______Business Address ______Tel. No. ______Mother’s Company______Position ______Business Address ______Tel. No. ______Guardian’s Company ______Position ______Business Address ______Tel. No. ______

3. Please list children still dependent (Use back of page if needed). Name Age School Tuition 1. 2. 3. 4.

4. List other dependents supported by you. (Use back of page if needed). Name Age Amount of Support 1. 2. 3.

5. Are there any major unusual expenses other than school costs which you must carry on an annual basis (alimony, traumatic illness, etc.):

______

Total Annual Amount: ______

6. List automobiles owned by members of the family:

Make Year 1. 2. 3. 4.

6 Parent’s Confidential Financial Statement

7. Family Income:

Total Last Year Total This Year Estimate Next Year Father Salary/Wages Other Income Mother Salary/Wages Other Income Guardian Salary/Wages Other Income Totals:

8. Parents’ or Guardian’s Value of Equity:

A. Life Insurance/Face Value B. Equity Value in Home C. Other Real Estate D. Stocks and Bonds E. Annuities

9. Mortgage and Other Indebtedness:

Monthly Payment Current Balance A. Home Mortgage B. Other Real Estate Loans C. Automobile Loans D. Other Personal Loans (specify) (Include school loans for children for which you are responsible.)

______Signature of Parent or Legal Guardian

7 Remember to hand this application in to your guidance counselor by 4/3/2009. Be sure you have included the completed application, and that both you and your parent/guardian have signed it. Be sure to include your letters of recommendation, school transcript, ,tax forms, and essay. All materials will be held in the strictest confidence.

Applicant’s Signature ______

Parent/Guardian Signature ______

Date ______