Kiwanis Club of Kirtland, Ohio
 
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KIRTLAND KIWANIS FOUNDATION
SCHOLARSHIP APPLICATION

​The scholarships are awarded each year, prior to the beginning of the fall term, to the persons determined by the Scholarship Committee to be the most deserving. The scholarship is available to a graduating senior or a graduate, who is a resident of the Kirtland School District. The applicant must also be pursuing a degree at an accredited college.

The Scholarship Committee of the Kiwanis Club of Kirtland will select the recipient(s). Although each recipient must demonstrated a capability for success in higher education as evidenced by high academic standing and standardized test scores, the award will not necessarily be awarded to the student with the highest academic standings. The Scholarship Committee looks for students who exemplify an overall representation of the criteria of the award.

Each recipient must demonstrate a genuine desire for higher education and have concrete aims and academic goals. Kiwanis is based on service to others. Consequently, the committee will strongly consider the applicant’s leadership, volunteer service, and involvement in extra-curricular school activities as well as participation in religious, civic, and social organizations.
The Scholarship Committee will consider the income, resources and obligations of the student. Failure to complete any and all sections of this application will have a direct effect on the selection process.

Students meeting the criteria of this scholarship are invited to apply by completing the following application on the attached forms. Additional copies are available from the Kirtland High School guidance department & Jeffrey C. Bailey, D.D.S. at 9191 Chillicothe Rd., Kirtland, Ohio 44094.

The deadline for receipt of the completed applications by the scholarship committee is April 1, 2016.
Please return applications to Jeffrey C. Bailey, D.D.S. at the above addresses before the application deadline in order for your application to be considered for the 2016-2017 term.


KIRTLAND KIWANIS FOUNDATION
SCHOLARSHIP APPLICATION



Name: _____________________________ Birthday: ___________________________
First Middle Last

Address: ___________________________ Home Phone: ________________________

City: _______________ Zip Code: __________________________

School now attending: ____________________________________________________

Other high schools attended: _______________________________________________

Academics:

Class Rank: _________ GPA: ___________

SAT and/or ACT Scores (Enter highest scores. They do not have to be from the same test dates):

(SAT Verbal: ________ Math: ________) (ACT English: _________ Math: __________

  ACT Reading: ________ Science Reasoning ________ Composite (1-36): ___________)

If you have taken any College Board achievement tests, please list up to three of your highest scores:

(Subj: _____ Score: ______) (Subj: ______ Score: _______) (Subj: _______ Score: ______)

If you have taken any advanced placement courses, please list up to 3 of your best scores (e.g. “4 or 5”):

(Subj: _____ Score: ______) (Subj: ______ Score: _______) (Subj: _______ Score: ______)

In the space below, please describe any courses taken outside of high school, e.g., at a local college:

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________


Academic awards and honors earned: ______________________________________________________________

______________________________________________________________________________________________

In the space below, feel free to add any additional information concerning academics not covered above, of which you may feel the committee should be aware: _______________________________________________________________

______________________________________________________________________________________________



Extracurricular Activities in High School:

Please describe your principal high school extracurricular activities below, and in each instance include: (a) any leadership position(s) you may have held; (b) any honors or awards you may have received in connection with the activity; (c) your years of participation; (d) whether or not you are still an active participant; and (e) briefly, anything else concerning the activity which you may feel might be helpful. If space is a problem here, or anywhere else on this form, please feel free to add additional page(s).

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

Community Activities:

Please describe your participation in any significant activities outside of school, e.g., scouting, church, volunteer work, etc., and in each instance include: (a) any leadership position(s) you may have held; (b) any honors or awards you may have received in connection with the activity; (c) your years of participation; (d) whether or not you are still an active participant; and (e) briefly, anything else concerning the activity which you may feel might be helpful.

_____________________________________________________________________________________________

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_____________________________________________________________________________________________

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Community Service:

Please describe any community service projects engaged in during your high school years, including those in and outside of school and the approximate dates of participation:

_____________________________________________________________________________________________

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_____________________________________________________________________________________________

_____________________________________________________________________________________________

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Work Experience:

Please list any jobs (including summer jobs) that you have held during your high school years, and in each instance: (a) the name of your employer; (b) the type of work; (c) the approximate number of hours per week that you worked at the job; (c) the dates during which you held the job; (d) briefly, anything else concerning the job which you feel might be helpful:

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

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College Choices:

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

Estimate College Expense Per Year:
1st Choice: _____________________________ 2nd Choice: ______________________________
                            (Name of College)                                             (Name of College)

                                                    1st Choice:                                               2nd Choice

Tuition and fees:                          $______________                    $________________

Room & Board:                             ______________                     ________________

Where I plan to live in College:       ______________                     ________________

Books, supplies, Recreation, etc.:  ______________                     ________________

Travel and unusual expenses:       _______________                   ________________
  (Describe Below)

Total Estimate Expenses:              ______________                   ________________

Please use this space for your explanation of travel and unusual expenses and any other information:
_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

Expected Sources of Financial Support for College Expenses:
Please use this space to describe and itemize any potential sources of support, such as scholarships and loans, Etc.

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

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Parents’ Marital Status: _____ Married _____ Separated _____ Divorced _____ Widow(er)
Father/Guardian: Name____________________ Occupation __________
Mother/Guardian: Name____________________ Occupation __________
Parents’ Annual Income before taxes: $_______________

Please list below all your brothers and sisters, if any; any other persons living in your home; and any other persons (wherever residing) who are dependant upon your parent(s) guardian(s) for financial support:

      Name                   Relationship to applicant          Age     School Attending      Living at Home
______________     _________________________    _____    ______________    _______________ 
______________     _________________________    _____    ______________    _______________ 
______________     _________________________    _____    ______________    _______________ 
______________     _________________________    _____    ______________    _______________ 
______________     _________________________    _____    ______________    _______________ 

Please explain any special family circumstances of which the Scholarship Committee should be aware:

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________


Education and Career Goals:
What are your education objectives? 

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

Please describe your career plans: 

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

Other Information:
Please use this space to provide any other information that you may wish to share: 

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

Essay:
On a separate sheet(s) of paper, please type a brief essay (not to exceed 1,000 words) on one of the following subjects:
1.A leadership role you have had, and what you have learned from the experience.
2.Your plans for serving the needs of individuals and society in the future.

To the best of my/our knowledge, I/we hereby certify that all statements in this application are true and correct:

Applicant’s Signature: _______________________________________________   Date: _____________

Parent/Guardian Signature: ___________________________________________  Date: ______________
(If Applicant is under 18 years of age)