Scholarship Application

CONFLICT OF INTEREST STATEMENT

In order to be awarded this scholarship, we need you to confirm that neither you nor a lineal descendant (defined as a parent or grandparent) are current Rotarians (members of a Rotary Club) or are current employees of a Rotary Club. Do you affirm this to be true? If you have a conflict of interest and are UNABLE to answer "YES" to this question, unfortunately your application will not be able to be considered for this scholarship.

YES

Once you have completed this form and attached all applicable documents click the submit button and it will send the application to the Bexley Community Foundation for review. Please check over your application thoroughly. Once you click submit you can not return to your saved application to make more edits. You will, however, receive an email containing a link to your completed form so that you may save and print it.

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Date of Birth

YYYY

Name of Parent or Guardian

First Name

Last Name

Your School

Scholarship Assessment

Question 1

Briefly describe your plans for continuing your education after you graduate from high school.

Question 2

If you have been accepted to a College or University, please state which one. If you are planning on attending a trade or vocational school, please state which one and what you plan to study / get certification.

Question 3

Is it true that being awarded a scholarship will help you in your pursuit of continued education? If so, how?

Question 4

Is is fair to say, that compared to your peers, you demonstrate an "above and beyond" commitment to service and action in your community, school and / or within your family? If so, please provide some examples. Examples could be community, school or family related (or some combination).

Question 5

Building good will and bettering friendships is a core value of Rotary. Can you give an example(s) of something you have done, participated in, or led that embodies this? Team based examples would be good (could be athletic, academic or community service related- or some combination)

Question 6

How is continuing your education going to be beneficial to you and the plans you have for the future?

Question 7

What else would you like the scholarship committee to know about you when deciding whom to award the scholarships to? If nothing, you can leave this blank.

Teacher Reccomendation

Teacher's Name

Name of teacher who will complete recommendation.

First Name

Last Name

Teacher's Email Address

E-mail of teacher who will complete recommendation. ***If this e-mail address is typed incorrectly no recommendation will be sent

Guidance Counselor Reccomendation

Guidance Counselor's Name

Please fill in the name of your guidance counselor

First Name

Last Name

Guidance Counselor's Email Address

E-mail of guidance counselor who will complete recommendation. ***If this e-mail address is typed incorrectly no recommendation will be sent

Line

Student Signature

By typing my name in the space below I am legally stating that I am the student on this application and I wish to be considered for the Rotary Club of Whitehall-Bexley Scholarship. Furthermore, by typing my name below, I also affirm that I do not have a parent or grandparent that is currently a member of, or employee of, a Rotary International Club.

First Name

Last Name