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Kiwanis Cal-Nev-Ha Foundation
www.cnhfoundation.org
8360 Red Oak Street, Suite 201 Rancho Cucamonga, CA 91730-0608 Office: 909-989-1500 Fax: 909-989-7779 Email: foundation@cnhkiwanis.org
Kiwanis Cal-Nev-Ha Foundation Scholarship Application Instruction Page
Cali-Nev-Ha Key Club & Cal-Nev-Ha KIWIN’S Received by Deadline: FEBRUARY
24, 2011
Note: Applications received after this date will NOT be considered by the judging committee. Mail to:
Kiwanis District Office, Attn. Service Leadership Programs Scholarships 8360 Red Oak St., Suite 201, Rancho Cucamonga, CA 91730-0608
Please clearly separate scholarship applications from convention registration and contest entries. This application will also be used as the initial application for the Loretta Barksdale McElwain scholarship with a value of approximately $20,000.00. Applicants will be requested to submit separately the Free Application for Student Aid (FAFSA) Student Aid Report to be considered for this award. Instructions: Please read all instructions before beginning the application process! 1. FOLLOW DIRECTIONS!!! 2. The application is divided into three sections but weighed differently a. Service as a Kiwanis Member (Key Club/KIWIN’S only)—60% of your score b. Service to your School (other than Key Club/KIWIN’S)—20% of your score c. Service to your Community—20% of your score NOTE: Duplication of activities in more than one section will not be considered by the judges. Specifically comment on your contribution to the project. Statements like “10/2006 I organized a blood drive that collected a school record of over 5,000 pints of blood” carries more weight with the judges than, “Blood Drive 10/2006” 3. Applicant must be a high school senior who plans to enroll full time in a college, university, or institution of higher education the next year. 4. Applicant’s name must appear on both District and International dues forms from the current year. 5. Complete the application. a. Limited to this pdf-fillable form only (Acrobat Reader is needed): Any modification or change to this form will not be considered by the judges. 1) You are limited to the number of slots provided. b. Entire application must be typed. ADOBE READER USERS: Form must be printed without saving. c. Times or Times Roman font only (Form default) d. Font size must be 9-point or higher (Form default) e. No attachments! f. SPECIAL NOTE—INTERNATIONAL SCHOLARSHIP APPLICATIONS: For those applying for International scholarships, please make a copy of this application to include with the International Scholarship cover page and all necessary attachments. This must be submitted at the same time as the Cal-Nev-Ha Foundation scholarship application to be considered by the judges. 6. Tips: Use dates. Record specific accomplishments, number of people served, awards received and recognition given. Provide sufficient information so the judges understand the nature of the project and your involvement in the project.
MISSION STATEMENT: The Kiwanis Cal-Nev-Ha Foundation Improves the Lives of Children and Their Communities.
Kiwanis Cal-Nev-Ha Foundation
www.cnhfoundation.org
8360 Red Oak Street, Suite 201 Rancho Cucamonga, CA 91730-0608 Office: 909-989-1500 Fax: 909-989-7779 Email: foundation@cnhkiwanis.org
Kiwanis Cal-Nev-Ha Foundation Scholarship Application Cover Page
Cali-Nev-Ha Key Club & Cal-Nev-Ha KIWIN’S Received by Deadline: FEBRUARY
24, 2011
I am applying for the following CNH scholarship. I am also identifying if I am applying for International scholarships.
Key Club
or
KIWIN’S
&
International
Note: Applications received without a category designation will NOT be considered by the judging committee. Applicant Name Last Name PERSONAL INFORMATION Address Street Home Phone E-mail KIWANIS FAMILY INFORMATION Parent(s) members of Kiwanis? (Y/N)
First Name
Middle Initial
City
State
Cell Phone
Zip
Social Security #
Previous K-Kids Member? (Y/N) Previous Builders Club Member? (Y/N)
MEMBERSHIP INFORMATION Member Identification #
Region
Years Years Division
(Obtain from club secretary or Key Club International)
# of years in Key Club/KIWIN’S? School Sponsoring Kiwanis Club
Total # of Key Club/KIWIN’S service hours? # of paid Members in club
ACADEMICS Applicant is a high school senior who plans to enroll full time in a college, university, or institution of higher education next year. (Y/N) Applicant’s FAFSA Student Aid Report will be available if requested? (Y/N) Academic (weighted) G.P.A. Verified by: Name Signature (select one) Faculty advisor Counselor School Registrar EMPLOYMENT Did you hold a job during high school? Where?
Average # of hours worked each week?
I verify that all information contained herein is correct Typed Name of Applicant
Signature of Applicant
MISSION STATEMENT: The Kiwanis Cal-Nev-Ha Foundation Improves the Lives of Children and Their Communities.
Date
KEY CLUB
Kiwanis Cal-Nev-Ha Foundation Scholarship Application
Page 2 of 4
NOTE: Duplication of activities in more than one section will not be considered by the judges. Check the criterion for each category before completing each section.
KEY CLUB/KIWIN’S SERVICE 60% of your score Indicate service completed as a Key Club/KIWIN’S member, projects chaired, service projects organized, events attended, offices held, etc. Indicate only the top twenty (20) service projects that you completed as Key Club/KIWIN’S member. Example: Name of the project or event Alumni Luau Service Project Junior High School Mentor Program
Your service:
Date (list multiple dates together)
6-07 11th- 12th grade
Describe your role and/or contribution to the project or event I coordinated more than 40 club members to volunteer I mentored two 7th grade students
KEY CLUB
Kiwanis Cal-Nev-Ha Foundation Scholarship Application
Page 3 of 4
NOTE: Duplication of activities in more than one section will not be considered by the judges. Check the criterion for each category before completing each section. Indicate only the top fifteen (15) Kiwanis Family events that you attended as a Key Club/KIWIN’S member. Example: Name of the project or event Key Club International Convention Kiwanis Club of Endor
Date (list multiple dates together)
7-07 Senior Year
Describe your role and/or contribution to the project or event I was the only delegate from my school to attend I attended one meeting per month
Your activities:
Indicate up to your top ten (10) offices or positions held and up to your top ten (10) honors received as a Key Club/KIWIN’S member. Indicate whether office positions are elected or appointed positions. Example: Leadership Positions Held Name of the office or position Division 100 Lt. Governor Project Chair
Your leadership positions:
When did you serve? 2006-2007 2005-2006
Example: Recognition or Honors Received Elected or Appointed? Elected Appointed
Name of the recognition Member of the Month Top Fundraiser: UNICEF
Your awards and recognitions:
Date (list multiple dates together) 4/2004, 10/2007 10-2006
KEY CLUB
Kiwanis Cal-Nev-Ha Foundation Scholarship Application
Page 4 of 4
NOTE: Duplication of activities in more than one section will not be considered by the judges. Check the criterion for each category before completing each section.
SERVICE TO THE SCHOOL 20% of your score Indicate offices held (other than Key Club/KIWIN’S) and participation in other organizations and projects. Indicate up to your top ten (10) offices held and participation in school organizations and projects not affiliated with Key Club/KIWIN’S. Example: Name of the project or event Yearbook Orchestra
Date (list multiple dates together)
11th grade 9th-12th grade
Describe your role and/or contribution to the project or event I was the art director I played violin, 1st chair
Your activities:
SERVICE TO THE COMMUNITY 20% of your score Indicate organizations and projects you were involved in through your religious institution, other community service groups not affiliated with Kiwanis or your school, and any activities accomplished on your own. Indicate up to your top five (5) community service involvement not affiliated with Kiwanis or your school. Example: Name of the project or event Sunday School Camp Sunshine
Your activities:
Date (list multiple dates together)
2007 8 weeks, 2007
Describe your role and/or contribution to the project or event I taught 2nd grade classes each week I was a summer camp counselor at the YMCA camp