KIWANIS CLUB OF ELLICOTT CITY
Application for Transfer Scholarship
Application for Transfer Scholarship
To the Kiwanis Club of Ellicott City.
I hereby make application for the Kiwanis Club of Ellicott City Scholarship for the college year starting in the Fall 20___. In addition to this application, please include a copy of the Student Aid Report (SAR) from your FAFSA (Free Application for Federal Student Aid).
(Please print in ink or type)
Name: _________________________________________________________________________
(Last) (First) (Middle)
Home Address: __________________________________________________________________
(Street)
__________________________________________________________________
(City & Zip) (Phone)
Social Security Number: ______ - ____ - ______ E-mail: _____________________________
Number of Years as a Resident of Howard County: ___________________________________
(Please provide proof. See Instructions)
Names of Parents/Guardians: _____________________________________________________
Family information that you feel might be pertinent for committee consideration:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
College Attended:
__________________________________________________________________ Year _____
__________________________________________________________________ Year _____
__________________________________________________________________ Year _____
College You Plan to Attend this Fall: ______________________________________________
Community Activities & estimate of hours
__________________________________________________________________ Year _____
__________________________________________________________________ Year _____
__________________________________________________________________ Year _____
Awards and Honors
__________________________________________________________________ Year _____
__________________________________________________________________ Year _____
__________________________________________________________________ Year _____
Financial Information
Father's (guardian's) Occupation: ___________________________________________
Place of Employment: _______________________________________________
Annual Income: ___________________________________________________
Mother's (guardian's) Occupation: ____________________________________________
Place of Employment: _______________________________________________
Annual Income: _________________________
Foster Parent stipend/support - Annual Income: _________________________
Additional factors affecting family finances: Medical, tuition, child support, and unusual situations.
___________________________________________________________________________
___________________________________________________________________________
Estimate of family's contribution for yearly college expenses: (dollar amount)
_______________________________________________________
Estimate of student's contribution for yearly college expenses (dollar amount)
(Savings, work, etc.): __________________________________________
Estimate of other support (loan, gift, scholarships) _______________________
Estimate of College Expenses
School ___________________
Tuition ___________________
Room/Board ___________________
Transportation ___________________
Miscellaneous ___________________
Totals ___________________
College or Institutional Loans for which you have applied:
___________________________________________________________________________
___________________________________________________________________________
Other Loans: _________________________________________________
Essay
Submit an essay describing what the student considers citizenship in the community to be and what he/she could do to improve active participation in the community by local Kiwanis Clubs. The essay should be no less than two (2) nor more than four (4) double spaced pages.
______________________________________________________ ____________
Applicant's Signature Date
Please return this completed application with a copy of your college transcript, the essay, and a completed copy of the FAFSA application to:
Kiwanis Club of Ellicott City
C/o Robert S. Scarburgh
8546 Marybeth Way
Ellicott City, Maryland 21043-6659
Submit these materials with a postmark no later than May 31, 2012.
NOTE: An unsigned application or missing data could be cause for an application not to be considered for this scholarship.
Rev: 2/11
