<p>Rotary International Super District 6400 </p><p>Trenton Rotary Club</p><p>P.O. BOX 161 • TRENTON • MICHIGAN 48183</p><p>Meetings: MONDAY Westfield Activities Center 12:00 P.M. 2700 Westfield • Trenton</p><p>TRENTON ROTARY SCHOLARSHIP APPLICATION POST-SECONDARY EDUCATION 2017</p><p>NAME: </p><p>ADDRESS: PHONE: </p><p>DATE OF GRADUATION: </p><p>COLLEGE, TRADE OR TECHNICAL SCHOOL CHOICE: </p><p>1 MAJOR: </p><p>2. MAJOR :</p><p>3. MAJOR :</p><p>FATHER'S OCCUPATION</p><p>MOTHER'S OCCUPATION HOUSEHOLD COMBINED INCOME: [ ] Under $25,000 [ ] $25-50,000 </p><p>[ ]$50-$75,000 [ ] $70-100,000 [ ] Over $100,000 </p><p>ACADEMIC INFORMATION: Use additional sheet if needed </p><p>CUMULATIVE GRADE POINT AVERAGE (4.0 GRADE POINT SCALE). </p><p>CLASS RANKING:</p><p>HIGH SCHOOL COUNSELOR' S NAME </p><p>EXTRACURRICULAR ACTIVITIES:</p><p>HONORS & AWARD: </p><p>ARE YOU A MEMBER OF THS INTERACT CLUB Y____ N____ </p><p>OFFICES OR POSITIONS HELD:</p><p>YEAR JOINED:</p><p>EMPLOYMENT: </p><p>COMPANY NAME/YOUR POSITION: </p><p>SUPERVISOR'S NAME / PHONE #</p><p>EMPLOYMENT DATES: </p><p>AVERAGE HOURS PER WEEK: COMMUNITY INVOLVEMENT & VOLUNTEER ACTIVITIES:</p><p>SPECIAL INTERESTS AND ACTIVITIES: </p><p>OTHER FINANCIAL AID YOU EXPECT TO RECEIVE (SCHOLARSHIPS, GRANTS, LOANS) </p><p>TEACHER / COUNSELOR REFERENCES (MINIMUM OF 3: NAME, ADDRESS & PHONE#) </p><p>1.) </p><p>2.) </p><p>3.) </p><p>4.) </p><p>PERSONAL REFERENCES: DO NOT USE FAMILY / RELATIVES (MINIMUM OF 3: NAME, ADDRESS & PHONE #) </p><p>1.) </p><p>2.) </p><p>3.) </p><p>4.)</p><p>PLEASE WRITE A SEPARATE 500 WORD ESSAY DESCRIBING YOUR COMMUNITY ACTIVITIES, YOUR INTERACT INVOLVEMENT, IF A MEMBER, AND HOW THESE HAVE AFFECTED YOUR CAREER GOALS. </p><p>I ATTEST THAT ALL STATEMENTS I HAVE MADE FOR THIS APPLICATION ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF. </p><p>X-APPLICANTS SIGNATURE: </p><p>I ATTEST THAT ALL STATEMENTS MADE ON THIS APPLICATION ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF. </p><p>X-PARENT'S SIGNATURE: </p><p>ALL INFORMATION WILL BE KEPT STRICTLY CONFIDENTIAL THIS APPLICATION IS TO BE DOWNLOADED AND COMPLETED ON THIS FORM, THEN PRINTED IN HARD COPY. SIGN BY STUDENT AND PARENT. RETURN COMPLETED APPLICATION TO THE TRENTON HIGH SCHOOL COUNSELING OFFICE NO LATER THAN. </p><p>WEDNESDAY MARCH 1, 2017</p><p>For more information about The Trenton Rotary visit the web site www.trentonrotary.net </p>