Scholarship Application-New

KIWANIS CLUB OF ELLICOTT CITY

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 _____

College You Plan to Attend this Fall: ______________________________________________

Applicant’s Name: ________________________________

Community Activities & estimate of hours

__________________________________________________________________ Year _____

Awards and Honors

__________________________________________________________________ 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.

___________________________________________________________________________

Applicant’s Name: ________________________________

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: _________________________________________________

Applicant’s Name: ________________________________

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 July 30, 2010.

NOTE: An unsigned application or missing data could be cause for an application not to be considered for this scholarship.

Rev: 7/10