Middleboro Rotary Club

MIDDLEBORO ROTARY CLUB SCHOLARSHIP APPLICATION DUE APRIL 1, 2012

NAME SCHOOL: ADDRESS:

FATHER’S OCCUPATION______EMPLOYER______AGE______MOTHER’S OCCUPATION______EMPLOYER______AGE______if either are deceased or if living with someone other than your parents, please note that

NUMBER OF SISTERS/BROTHERS UNDER 21 YEARS OF AGE?______

IF ANY WILL ALSO BE ATTENDING COLLEGE NEXT FALL, PLEASE LIST THEIR NAME & SCHOOL

IF YOU HAVE BEEN EMPLOYED DURING THE PAST FOUR YEARS, EITHER DURING THE SCHOOL YEAR OR DURING THE SUMMER, PLEASE COMPLETE THE FOLLOWING: (Attach an extra sheet if necessary)

EMPLOYER DATES WORKED TOTAL EARNINGS

PLEASE LIST ANY ACADEMIC HONORS (WITH DATES) RECEIVED DURING HIGH SCHOOL: *Please attach school generated list of honors & activities

PLEASE LIST HIGH SCHOOL EXTRA-CURRICULAR ACTIVITIES (WITH DATES) IN WHICH YOU HAVE BEEN INVOLVED.

PLEASE LIST ALL COMMUNITY SERVICE ACTIVITIES (WITH DATES) IN WHICH YOU HAVE BEEN INVOLVED OVER THE PAST FOUR YEARS.

ARE THERE ANY SPECIAL FAMILY CONDITIONS OR FINANCIAL CHALLENGES THAT MAY AFFECT YOUR ABILITY TO ATTEND COLLEGE/SCHOOL IF YOU DO NOT GET SCHOLARSHIP SUPPORT?

PLEASE COMPLETE THE FOLLOWING FOR EACH COLLEGE OR NURSING SCHOOL TO WHICH YOU HAVE APPLIED: Please list the school you will most likely attend 1st. NAME OF LOCATION ACCEPTED WAITING TOTAL PLANNED COLLEGE/SCHOOL TO HEAR COST* COURSE OF STUDY 1. 2. 3. 4.

*Total costs include: tuition, room and board, fees, books or tools and other miscellaneous expenses.

HOW MUCH MONEY HAVE YOU SAVED TOWARD YOUR COLLEGE/SCHOOL EDUCATION (INCLUDE GIFTS, EARNINGS, ETC.)?

WHAT WAS YOUR PARENTS COMBINED ANNUAL INCOME FROM ALL SOURCES (ADJUSTED GROSS INCOME FROM THE 2011 TAX RETURN)?

HAVE YOU FILED THE FAFSA FORM? Yes No

Your Expected Family Contribution (EFC) is

FINANCIAL AID RECEIVED TO COLLEGE COLLEGE COLLEGE COLLEGE DATE #1 #2 #3 #4 TOTAL GRANTS / SCHOLARSHIPS FROM EACH SCHOOL TOTAL OTHER SCHOLARSHIPS TOTAL LOANS / WORKSTUDY

UNMET NEED (ANNUAL COST – YOUR KNOWN FINANCIAL AID)

PLEASE ATTACH: 1. AN ORIGINAL ESSAY ON THE IMPORTANCE OF VOLUNTEERING IN YOUR COMMUNITY INCLUDING YOUR PERSONAL EXPERIENCES. 2. ALL HIGH SCHOOL TRANSCRIPTS INCLUDING CLASS RANK AND ATTENDANCE RECORD 3. A LETTER OF REFERENCE FROM A TEACHER OR GUIDANCE COUNSELOR

May be returned to: Middleborough, Apponequet, Bristol Plymouth or Old Colony Regional High School Guidances offices or to the Middleborough Public Library. - Or – Mail to: Middleboro Rotary Club P.O. Box 596 Middleboro, MA 02346