Scholarship Application

Hidden

Next Steps: Sync an Email Add-On

To get the most out of your form, we suggest that you sync this form with an email add-on. To learn more about your email add-on options, visit the following page (https://www.gravityforms.com/the-8-best-email-plugins-for-wordpress-in-2020/). Important: Delete this tip before you publish the form.

About You

Your Name(Required)

First Middle Last

Date of Birth

Gender(Required)

Male

Female

Citizen/Resident Alien(Required)

Yes

Your Address(Required)

Street Address Address Line 2 City ZIP Code

How Can We Reach You?

Preferred Method of Contact(Required)

Your Email Address(Required)

Email Address Confirm Email Address

Your Phone(Required)

Best Time to Call You(Required)

High School Data

Name of Highschool(Required)

Graduation Date

Parent/Guardian Information

Name of Parent/Guardian - 1

First Middle Last

Address of Parent/Guardian - 1

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name of Parent/Guardian - 2

First Middle Last

Address of Parent/Guardian - 2

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Family Information

Are there any extenuation circumstances concerning your financial needs that may assist the committee in making its decision (i.e. medical issue, business challenges)

Number of Dependents

Do you have any siblings who will attend college at the same time as you?(Required)

Yes

If so, what age are your college aged siblings?

Are there any extenuation circumstances concerning your financial needs that may assist the committee in making its decision (i.e. medical issue, business challenges)

Planned Post High School Data

I have attached an acceptance letter (if available)(Required)

Yes

Name of College, University, Vocational or Technical/Trade School(Required)

Major

Address of College, University, Vocational or Technical/Trade School(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name of Scholarships/Grant - Amount(Required)

Please list any scholarships, grants, or assistance you anticipate receiving to fund your university, college, or vocational/technical school expenses. (Attatch copies of scholarship and grant award letters belo).

School Extra Curricular Activities (9th 10th 11th 12th)(Required)

List your school activities in which you have participated during the last 4 years (i.e.: clubs, sports, studentgovernment, music). Indicate all special awards and honors. List all leadership positions or offices held. Include the years of participation for each activity or honors.

Community Service: Avtivity Name | Explanation of Duties | Leaders Name | Number of Hours(Required)

List the major areas of Community Service in which you have been involved during your high school career (i.e.: hospital, volunteer, food drivices, church volunteer, service organization volunteer, etc.)

Total Number of Service Hours in High School

Work Experience

Do you plan to work the summer before you begin college?(Required)

Yes

Type of work | Date started | Date ended | Name of employer | Hourly wage(Required)

List your work experience in the last 4 years.

Essay Submittal: It's fifteen years in the future... tell us about your life, who do you think you'll become and what you're doing?(Required)

Please copy and paste a written essay into this section. The essay should be clear, concise and no more than 500 words.

Submittal Checklist

Attachments

Please attach the documents as noted in the above checklist. Contact Us for questions: 954.552.2985 | info@zMarketingAndDesigns.com

Attachments: see checklist above - PDF, DOC, JPEG(Required)

Drop files here or

Max. file size: 32 MB.

Your Comments/Questions(Required)

2024 PBLH Rotary Club Scholarship Application

Next Steps: Sync an Email Add-On

About You

How Can We Reach You?

High School Data

Parent/Guardian Information

Planned Post High School Data

Work Experience

Attachments