Renew Appl

KIWANIS CLUB OF ELLICOTT CITY
Application for Scholarship Renewal

To the Kiwanis Club of Ellicott City.

I hereby make application for renewal of the Kiwanis Club of Ellicott City Scholarship for the college year starting August/September, 20___. In addition to this application, please include a copy of completed courses and grades for the previous school year.

(Please print in ink or type)

Name: __________________________________________________________
          (Last)            (First)            (Middle)

Home Address: __________________________________________________
                            (Street)

            ___________________________________________________
                            (City & Zip)         (Phone)

E-mail address: _______________________________

Social Security Number: ______ - ____ - ______

University/College presently attending: ________________________

Estimate of school expenses for the next year:

Tuition      _______________    Books    _______________

Room/Board   _______________    Total    _______________

_______________________________________      ____________
  Applicant's Signature                                Date

____________________________________         ____________
     Parent's/Guardian's Signature                  Date

Please return this application with a copy of your college transcript to:

  Kiwanis Club of Ellicott City
  c/o Robert S. Scarburgh
  8546 Marybeth Way
  Ellicott City, Maryland 21043-6659
  Phone (410) 465-2421 E-mail: rscarburgh@aol.com
Submit these materials no later than June 15.
Rev. 2/97

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