West Salem Rotary Scholarship

High School Seniors who reside in West Salem are encouraged to apply for this local scholarship. The deadline for applications is March 16, 2012, but it's best to apply early.  Although the application is brief (see below), you have a better chance of winning this scholarship if you put extra time and detail into your application.  To apply, cut/paste the application below into a MS Word or other word processing software, complete the application, and mail it to the address specified.  See me if you have any questions.

WEST SALEM ROTARY CLUB

SCHOLARSHIP APPLICATION

NAME_________________________________________________________________

ADDRESS______________________________________________________________

                  _______________________________________________________________

Phone         ______________________________________________________________

BIRTHDAY _________________    YEAR__________                 G.P.A.____________

NAME OF PARENTS____________________________________________________

ADDRESS ______________________________________________________________

                    ______________________________________________________________

OTHER SIBLINGS (Names & Ages)________________________________________

                    ______________________________________________________________

PARENT OCCUPATION/S_________________________________________________

                       

                    ______________________________________________________________

PARENT INCOME – Under $50K______$50-75_____$75-100_____OVER $100_____

STUDENT SCHOOL FINANCING – From Savings______________%

                                             

                           From Parents ______________%

                           From Others _______________%

HIGH SCHOOL ATTENDED_____________________________________________

           

             

UNIVERSITY OR TRADE SCHOOL NEXT YEAR

                        1. __________________________________________________________

2. ____________________________________________________

WHAT IS YOUR INTENDED MAJOR_____________________________________

-2-

How would you describe yourself ____________________________________________

________________________________________________________________________

________________________________________________________________________

Would you prefer to be liked or respected by your friends and fellow students?  Why?

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

What are you most proud of in your life________________________________________?

________________________________________________________________________

________________________________________________________________________

Please prepare a one-page document covering your community activities, future plans and goals, which should be attached to this application.

            Parents or Guardian’s Signature – I certify this to be true.

                                                ________________________________________________

Please return to:  West Salem Rotary Club

                             C/o Gene Schlabach

                             1130 Wallace Road NW   

                              Salem, OR 97304