Rotary Club of Hyannis

College Scholarship Application

Six Scholarships to be Awarded in 2016
To Current Students Completing Their Degrees At
Cape Cod Community College

These scholarships are designed to support further college or university study during the 2016-17 academic
year after degree completion at Cape Cod Community College. The details of the scholarships are:
2 scholarships = $2,500
3 scholarships = $1,500
1 scholarship = $1,500 (awarded for further study in the
fields of psychology, social
work, or counseling)
The evaluation criteria used to determine these scholarships will include:
Academic Achievement

Service to the Community

Leadership in Activities

Financial Need

Please complete the attached scholarship application and submit it via email attachment by no later than
Monday, April 25, 2016 to ehieser@sturgischarterschool.org.

Scholarship Materials Checklist:

Completed Scholarship Application Form (attached)
Unofficial Copy of Your College Transcript

Student Applicant:
First Name:

Last Name:

___________________________

I certify that the information provided on this Rotary Club of Hyannis Scholarship Form is
complete and accurate to the best of my knowledge.
If requested I agree to furnish proof of the information I have submitted.

Date:

Applicants Signature:

/_

/____

Student Demographic Information:

Gender: Female (

Male (

Date of Birth:

_/

Address:
State:

City:
Telephone Number: (

Zip:

Student High School Information:

Name and Location of High School _____________________________________________________
Year of Graduation ___________
How many AP/IB courses you took if any
Participation in Activities/Leadership/Service____________________________________________

___________________________________________________________________________
_
___________________________________________________________________________
_
___________________________________________________________________________
_
College Student Information
Month & Year Completing Course Requirements at Cape Cod Community College __________
Approximate GPA _____________ (Please include a copy of your unofficial college transcript)
Work Experience While in College _______________________________________________
College Activities, Clubs, Leadership, Service: ______________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Colleges to which you have applied:

College

Admissions Status

Intended Major

If necessary , feel free to attach a list of additional colleges.

Career Plans:
Financial Information:
Supported by Parents ______ or Independent ______ (choose one)
Family Income 2015: ________ Anticipated Income 2016: __________
Number in household:
Number of family members who will be attending college in 2016/2017:
Which College do you hope to attend:

Annual Costs:

Tuition
Room/Board
Fees

Please explain any unusual financial need that you might have to further your studies at university.
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

_____________________________________
Thank you for your application.
Please remember to submit your scholarship application via email attachment by no later than

Monday, April 25, 2016 to ehieser@sturgischarterschool.org.

Eric Hieser, Chair
Hyannis Rotary Scholarship Committee
P.O. Box 39
Hyannis, MA 02601
Phone: 508-776-6801