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