APPLICATION

Olathe Noon Rotary

High School Scholarship Application

The object of Rotary is to encourage and foster the ideal of service as a basis of worthy
enterprise, and the advancement of international understanding, good will, and peace through
a world fellowship of business and professional persons united in the ideal of service.

One $750 scholarship will be awarded at each of the four Olathe high schools
and applications are open to all graduating seniors.

Return this application to your high school principal or counselor on or before March 1st.
Students related to members of the Olathe Noon Rotary Club are ineligible to apply.

Personal Information
Full Name:

______________________________________________________________________

Mailing Address:

____________________________
____________________________

Father/Guardian:
Employer:
Mother/Guardian:
Employer:

____________________________
____________________________
____________________________
____________________________

Telephone:
Email:

_________________________
_________________________

Position:

_________________________

Position:

_________________________

Educational Experience
High school:
GPA:

____________________________
_____ out of ______

Distinctions, honors and awards:

Extracurricular school activities:

Graduation date:
Class rank:

___________________
_____ out of ______

Leadership, Service, Work Experience

Community activities (scouting, church work, etc.):

Nonacademic activities and interests (hobbies, sports, etc.):

Work experience (Employer, dates, nature of work):

Finance
Parents' taxable income (from 1040, 1040EZ or 1040A form), circle one:
$0-10,000

$10-20,000

$20-30,000

$30-40,000

Number of dependent children ______

$40-50,000

$50-60,000

+$60,000

Number of children in college next year ______

Unusual expenses or financial circumstances:

Which college do you plan to attend?

Annual expenses
Tuition
Room and board
Books
Travel
Personal expenses
Total

__________________________________________
Annual assets available for expenses
Parents' contribution
__________
Student's contribution
__________
Scholarships, grants
__________
Other sources (explain)
__________
Projected student income
__________
Total
__________

__________
__________
__________
__________
__________
__________

Goals and Aspirations

Please attach a short essay discussing why I want to go to college and what outcomes will result from that
experience.

Additional Requirements
Please accompany this application with a copy of your high school transcript, including a copy of your ACT/SAT
scores. Also include sealed confidential references from one high school teacher and two adults who know you
but are not related to you.

Confirmation
The content of this form is accurate and the application is being made with my approval.
Signature of Parent

_______________________________________________________

Signature of Applicant

_______________________________________________________

Date

__________________