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HHF Application Form
HHF Application Form
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2020-03-06T20:50:30+00:00
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THE WETHERSFIELD/ROCKY HILL ROTARY CLUB HELPING HAND FUND SCHOLARSHIP AWARDS PROGRAM
Dear Student:
The Scholarship Program of our local Wethersfield/Rocky Hill Rotary Club is designed primarily to help students with limited financial resources continue their education past high school. In addition to financial need, academic record, character, relationships with fellow students and extra-curricular activities in school and community are considered.
A limited number of regular scholarships are granted annually, currently in the amount of $4,000 per year. Any student living in Wethersfield or Rocky Hill may apply.
To be considered for a personal interview with members of the Scholarship Committee (the final stage of the application process), each applicant must:
1. Complete the enclosed application and sign where indicated.
2. Discuss it with your parent(s) or guardian(s) and have them sign the completed application where indicated.
3. Please attach a copy of your high school yearbook photograph.
4. Mail the completed application and required attachments before April 15. Personal interviews are usually scheduled for early May.
Normally, scholarship payments are made twice each year. All scholarship winners are required to submit their college transcript to us at the end of each semester in order to maintain the scholarship and receive each payment.
A scholarship can be rescinded for:
1. Failure to maintain scholastic grades as prescribed by the college or university at which the student is enrolled. 2. Breach of college discipline rules. 3. Other changes in the financial or personal circumstances that affect the student and may have altered the original decision to grant the scholarship.
The Wethersfield/Rocky Hill Rotary Club takes a personal interest in each of its Scholarship students, and appreciates the contacts it has with each one, during and following college years. Letters and other communications are always welcome.
Please retain this letter and a copy of the confidential scholarship application for your files. Mail the original signed application and attachments to:
Rotary Club Scholarships P.O. Box 290116-0116 Wethersfield, CT 06129
***FAILURE TO TIMELY SUBMIT TWO CONSECUTIVE RENEWAL APPLICATIONS WILL RESULT IN THE FORFEITURE OF ALL FUTURE PAYMENTS***
THE HELPING HAND FUND OF THE ROTARY CLUB OF WETHERSIFELD/ROCKY HILL, INC.
Scholarship Application
General Information
The Scholarship Committee welcomes students and their parent(s)/guardian(s) to our educational assistance program. The program is based primarily upon financial need. Additional factors which will be reviewed are academic work, character, interaction with fellow students and extracurricular activities.
This scholarship is renewable each semester by submitting a transcript at the end of each semester. Payments will be made for the usual 2 or 4 years of an educational program, provided all requirements are fulfilled.
All the information requested will be kept confidential. An application will only be considered if all the required information is submitted on or by April 15. If there is not enough room, please attach additional sheets.
In addition to the items requested on page four, please include your high school transcript and College Board scores and letters of recommendations. All information and correspondence should be mailed to:
Rotary Club Scholarships P.O. Box 290116-0116 Wethersfield, CT 06129
We hereby certify that we have read all information supplied on the following pages of this application and the other material submitted in support of this application. We further certify that all of this information is true, complete and correct. We agree to notify the Committee of any change of circumstances which may alter the accuracy of any of this data. We agree the Committee and Helping Hand Fund can identify, take and use photos of all scholarship recipients for announcement and promotional purposes.
Applicants should retain the covering letter and a copy of the completed application.
Once submitted, application and all attachments become and remain the property of the Helping Hand Fund of the Rotary Club of Wethersfield/Rocky Hill, Inc.
Signature of Student
*
Date
*
MM slash DD slash YYYY
Signature of Parent/Guardian
*
Date
*
MM slash DD slash YYYY
Signature of Parent/Guardian
Date
MM slash DD slash YYYY
PERSONAL INFORMATION
*
First
Middle
Last
Email
*
Address
Address
City
State
ZIP
Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Date
DD slash MM slash YYYY
Phone
Social Security
High School
Location
Graduation Date
Father or Guardian
Name
Address
Street Address
City
State / Province / Region
ZIP / Postal Code
Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Occupation
Employer Name
Mother or Guardian
Name
Address
Street Address
City
State / Province / Region
ZIP / Postal Code
Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Occupation
Employer Name
Others Members of your household
Name
Age
Address
Student occupation/status
Employer/School
Intended area of study
EDUCATIONAL INFORMATION
Academic Record and Achievements
Approximate grade average in high school
Approximate rank in high school class
Special academic awards, recognitions, achievements, etc.
POST HIGH SCHOOL OR COLLEGE INFORMATION
Educational institutions 1
Name
Location
Accepted
Waiting
Educational institutions 2
Name
Location
Accepted
Waiting
Educational institutions 3
Name
Location
Accepted
Waiting
Intended area of study
FINANCIAL INFORMATION
Costs for institutions 1
Name
Tuition
Room & Board
Other
Costs for institutions 2
Name
Tuition
Room & Board
Other
Costs for institutions 3
Name
Tuition
Room & Board
Other
Intended housing arrangements while in school, check one
Dormitory
Commute
Apartment
Other
Please enter your estimated family contributions (EFC) as calculated on your FAFSA form
OTHER INFORMATION
What are your career and life goals?
Why did you select your particular school?
List all employment history, include: name of employer, location, title, dates employed and amount earned. (Last employer first, please.)
List school and community activities, include: class, officership, club memberships, club officerships, sports, volunteer efforts, etc.
Are there any special circumstances involving you or your family the Scholarship Committer should know about? Please explain.
Attach three or more letters of recommendation. The recommendations could be from teachers, club officers, employers, religious leaders, family friends, etc. Attach any news articles, documents of achievement or samples of school work you may wish the committee to see. Please describe attachments here
File
Max. file size: 120 MB.
File
Max. file size: 120 MB.
File
Max. file size: 120 MB.
File
Max. file size: 120 MB.
File
Max. file size: 120 MB.
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