Tualatin Rotary Club
Academic Scholarship Application
Name:___________________________________________________________
Last First Middle
Home Address:_____________________________________________________
Street City State Zip Code
Date of Birth: ______________ Graduation Date: ___________________________
I plan to attend___________________________ beginning: __________________
My proposed major field of study is: _______________________________________
Have you been an exchange student? ______________________________________
Has college/technical school been confirmed? ________________________________
Are you in the IB program? Yes_______ No______
Names of Parents/Guardians: ___________________________________________
Address: __________________________________________________________
Street City State Zip Code
Father’s Occupation: _________________Mother’s Occupation: _________________
Brothers Y Sisters (Names & Ages) ________________________________________
School Activities and Honors
List School activities in which you have been involved, offices held and the number of hours that you have contributed:
Activity Office Held Hours Spent Teacher/Sponsor
1._______________________________________________________________
2._______________________________________________________________
3._______________________________________________________________
4._______________________________________________________________
Favorite school subjects and why you enjoy them: _________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Courses currently taking: ______________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
List musical instruments you play(ed) drama productions, sports other activities: _________________
__________________________________________________________________________________
__________________________________________________________________________________
High school and community honors and awards received: ____________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Financial Need
How do you plan on financing your college/technical school education? ________________________
__________________________________________________________________________________
Citizenship and Community
Additional information may be attached, or you may write on the back of this sheet.
In what community organizations have you participated? Describe your participation in the organization: _______________________________________________________________________
__________________________________________________________________________________
List hobbies or leisure-time activities you enjoy: ___________________________________________
__________________________________________________________________________________
Work Experience: List the last two employers and responsibilities: ____________________________
__________________________________________________________________________________
What are your goals?
1 year: ____________________________________________________________________________
5 year: ____________________________________________________________________________
10 year: ___________________________________________________________________________
Why should you receive a Tualatin Rotary Club Scholarship? _________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Is there anything else the scholarship committee should consider? _____________________________
__________________________________________________________________________________
WRITE A ONE PAGE ESSAY ON ROTARY. What it is and what it does (locally, nationally and internationally)
To be completed and signed by high school principal or counselor:
Class Rank: __________ of __________
S.A.T. Scores: Verbal______ Math ______ T.S.W.E. ______ ACT: ______
GPA (Last 7 semesters): ______ Attendance at TuHS from __________ to __________
Signature authorizes the release of information to the Rotary Scholarship Committee
___________________________________ ________________________________________
Signature of Applicant Date Signature of Principal/Counselor Date
