Rotary Scholarship 2013 Application Form
GLENS FALLS ROTARY CLUB
PO Box 4702
Queensbury, NY 12804
Community Service Scholarship Application
NAME: __________________________________________ HIGH SCHOOL _______________________
Home Phone #: __________________ Cell Phone #: __________________ E-mail __________________
This completed application (typed in Word or other word processing software), and the additional documentation described at the bottom of this form, must be e-mailed by March 15, 2013.
- Please write a short essay describing your community service activities, and explain how your involvement or leadership role exemplifies the Rotary motto, “Service Above Self.” Feel free to attach a separate sheet, or you may write in the space below:
- Please tell us about your post- high school graduation plans.
The following additional documentation must also be submitted by the deadline:
- 1. A brief letter of support from the leader of an organization which benefited from your service, describing the impact of your involvement. This should be sent under separate cover directly to David Kisselback, Chairman of Rotary’s Scholarship Committee (see contact information below).
- 2. The Guidance Counselor Certification Form signed by your Guidance Counselor confirming that you meet the minimum required “B” average. Please DO NOT provide your high school transcript and DO NOT provide copies of your Counselor’s college Letter of Recommendation.
Please forward this completed application and required additional documentation (via e-mail) to: David Kisselback at email@example.com Please email any questions to the same address. Thank you.