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Rotary Scholarship Application

For 2011-2012 School Year

Name:

Address: Phone:

City/State/Zip: Email:

High School:

Counselor's Name: Phone:

Graduation Date:

Central Community College System:

Hastings Columbus Grand Island Kearney Other:

North Platte (Mid-Plains Community College)

Area of Study (optional):

Please list 2 character references:

1) Name: Phone:

Address:

2) Name: Phone:

Address:

Please attach a letter explaining why you want to receive this scholarship.

Include any relevant material such as extra-curricular activities, class listing, letters of recommendation, etc.

Signature: Date:

Return requested materials to Rotary Scholarship - 206 E. 6th St. Kearney, NE 68847 by April 1, 2011.

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