KIWANIS CLUB OF ELLICOTT CITY
Application for 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 August/September, 20___. In addition to this application, please include a completed copy of the 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: _____________________________
Date and Place of Birth: __________________________________________________________
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:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Educational Information:
Howard County Public High School presently attending:___________________ _____________
School Activities (Grades 9-12)
_________________________________________________________________ Year _____
__________________________________________________________________ Year _____
__________________________________________________________________ Year _____
Applicant's Name: _____________________________________
Community Activities
__________________________________________________________________ Year _____
__________________________________________________________________ Year _____
__________________________________________________________________ Year _____
Awards and Honors
__________________________________________________________________ Year _____
__________________________________________________________________ Year _____
__________________________________________________________________ Year _____
Colleges to Which You Have Applied
____________________________________________________________________________
____________________________________________________________________________
Colleges Which Have Accepted You
____________________________________________________________________________
___________________________________________________________________________
Financial Information
Father's (guardian's) Occupation: ___________________________________________
Annual Income: ___________________________________________________
Mother's (guardian's) Occupation: ____________________________________________
Annual Income: _________________________
Foster Parent stipend/support - Annual Income: _________________________
Applicant’s Name: :________________________________
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
First Choice Second Choice Third Choice
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) typed, double spaced pages.
______________________________________________________ ____________
Applicant's Signature Date
______________________________________________________ ____________
Parent’s/Guardian’s Signature Date
Please return this completed application with a copy of your high school 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 March 15.
NOTE: An unsigned application or missing data could be cause for an application not to be considered for this scholarship.
Rev: 05/00
