scholarshipapplicationform

NORTH STOCKTON ROTARY CLUB

P O Box 7184, Stockton, California 95267

APPLICATION FOR

NORTH STOCKTON ROTARY CLUB SCHOLARSHIP 2009

PLEASE CHECK ONE APPROPRIATE BOX

⁯CLIFF DOCHTERMAN SCHOLARSHIP ($1,500)

(For the University of the Pacific only)

⁯SCHOLARSHIP FOR COLLEGE/UNIVERSITY ($1,500)

(Two available)

SCHOLARSHIPS IN THE AMOUNT OF $1,500 WILL BE AWARDED BY THE NORTH STOCKTON ROTARY CLUB FOR
THE PURPOSE OF HELPING PROMISING YOUNG MEN AND WOMEN TO CONTINUE THEIR EDUCATION. TO QUALIFY
FOR THESE SCHOLARSHIPS, APPLICANTS MUST ATTEND A STOCKTON HIGH SCHOOL. THE AWARDS ARE BASED
UPON THE COMMUNITY SERVICE ACTIVITIES OF THE APPLICANT, THE IDEALS OF ROTARY, AND A SENSE OF
RESPONSIBILITY TOWARD EDUCATION. THE AWARDS ARE GRANTED WITHOUT REGARD TO RACE, RELIGION,
CREED, OR NATIONAL BACKGROUND. APPLICANTS MAY BE REQUIRED TO ATTEND AN INTERVIEW SESSION.

IMMEDIATE FAMILY MEMBERS OF ROTARIANS ARE NOT ELIGIBLE FOR THESE SCHOLARSHIPS.

NOTE: THE FORM IS TO BE COMPLETED IN FULL BY THE APPLICANT. THE APPLICATION MUST ALSO BE
ACCOMPANIED BY THE ESSAY AND TWO LETTERS OF REFERENCE. THE APPLICATION AND OTHER REQUIRED
INFORMATION SHALL BE RETURNED TO THE ADVISOR OR COUNSELOR WHO PROVIDED THE APPLICATION TO
YOU. IF NOT APPLYING THROUGH A COUNSELOR, PLEASE RETURN THE APPLICATION, ESSAY, AND LETTERS OF
REFERENCE TO THE NORTH STOCKTON ROTARY ADDRESS ABOVE. PLEASE RETURN THE APPLICATION TO THE
COUNSELOR OR ADVISOR AS SOON AS POSSIBLE.

DEADLINE: THE APPLICATION MUST REACH NORTH STOCKTON ROTARY BY APRIL 15, 2009.

ESSAY: PLEASE ATTACH A SHORT ESSAY ON THE TOPIC "EDUCATION AND SERVICE TO OTHERS". YOU MAY
INCLUDE YOUR LONG RANGE GOALS, OBJECTIVES, AND REASONS FOR CONTINUING YOUR EDUCATION.

REFERENCES: PLEASE PROVIDE TWO LETTERS OF REFERENCE. THESE MAY BE PERSONAL FRIENDS, ADVISORS,
COUNSELORS, TEACHERS, OR COMMUNITY SERVICE LEADERS.

NAME OF REFERENCE_________________________________________________________

ADDRESS_________________________________City/State/Zip________________________

PHONE NUMBER__________________________

NAME OF REFERENCE_________________________________________________________

ADDRESS_________________________________City/State/Zip________________________

PHONE NUMBER__________________________

APPLICATION FOR

NORTH STOCKTON ROTARY CLUB SCHOLARSHIP 2009

NAME OF APPLICANT_________________________________________________________

HOME ADDRESS _____________________________________________________________

CITY/STATE/ZIP ____________________________TELEPHONE (209) ________________

E-MAIL ADDRESS ____________________________________________________________

NAME OF CURRENT SCHOOL________________________________

DATE OF GRADUATION___________

ANY SUPPLEMENTAL SCHOOLING (be specific) ____________________________________

______________________________________________________________________________

WHICH EDUCATIONAL INSTITUTION(S) ARE YOU PLANNING TO ATTEND?

______________________________________________________________________________

OCCUPATIONAL GOAL________________________________________________________

______________________________________________________________________________

HAVE YOU WORKED? ____ DESCRIBE YOUR EXPERIENCE__________________________

_______________________________________________________________________________

_______________________________________________________________________________

LIST THE EXTRACURRICULAR OR COMMUNITY SERVICE ACTIVITIES IN WHICH YOU HAVE TAKEN PART?

________________________________________________________________________

NOTE: Don’t forget to attach the essay and the letters of reference to the application.

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