<p> MIDDLEBORO ROTARY CLUB SCHOLARSHIP APPLICATION DUE APRIL 1, 2012</p><p>NAME SCHOOL: ADDRESS:</p><p>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</p><p>NUMBER OF SISTERS/BROTHERS UNDER 21 YEARS OF AGE?______</p><p>IF ANY WILL ALSO BE ATTENDING COLLEGE NEXT FALL, PLEASE LIST THEIR NAME & SCHOOL</p><p>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)</p><p>EMPLOYER DATES WORKED TOTAL EARNINGS</p><p>PLEASE LIST ANY ACADEMIC HONORS (WITH DATES) RECEIVED DURING HIGH SCHOOL: *Please attach school generated list of honors & activities</p><p>PLEASE LIST HIGH SCHOOL EXTRA-CURRICULAR ACTIVITIES (WITH DATES) IN WHICH YOU HAVE BEEN INVOLVED.</p><p>PLEASE LIST ALL COMMUNITY SERVICE ACTIVITIES (WITH DATES) IN WHICH YOU HAVE BEEN INVOLVED OVER THE PAST FOUR YEARS.</p><p>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?</p><p>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.</p><p>*Total costs include: tuition, room and board, fees, books or tools and other miscellaneous expenses.</p><p>HOW MUCH MONEY HAVE YOU SAVED TOWARD YOUR COLLEGE/SCHOOL EDUCATION (INCLUDE GIFTS, EARNINGS, ETC.)?</p><p>WHAT WAS YOUR PARENTS COMBINED ANNUAL INCOME FROM ALL SOURCES (ADJUSTED GROSS INCOME FROM THE 2011 TAX RETURN)?</p><p>HAVE YOU FILED THE FAFSA FORM? Yes No </p><p>Your Expected Family Contribution (EFC) is</p><p>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</p><p>UNMET NEED (ANNUAL COST – YOUR KNOWN FINANCIAL AID)</p><p>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</p><p>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</p>