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 Key Club Received by Deadline: FEBRUARY
21, 2013
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 (CNH/KIWIN’S Key Club only)—60% of your score b. Service to your School (other than CNH/KIWIN’S Key Club)—20% of your score c. Service to your Community (other than CNH/KIWIN’S Key Club)—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 Organized PTP car wash; 20 members; raised $5000” carries more weight with the judges than, “Car Wash 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 (except for signature lines) 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! 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:
Building a better future for our children
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 Key Club Received by Deadline: FEBRUARY
21, 2013
I am applying for the following CNH scholarship.
CNH Key Club
KIWIN’S Key Club
or
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 # of years in CNH/KIWIN’S Key Club? 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)
Years Years
MEMBERSHIP INFORMATION (Obtain from club secretary or Key Club International)
Member Identification # Club Sponsoring Kiwanis Club
Region
Division Club Identification #
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. This school does not weigh grades. (check if appropriate) 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:
Building a better future for our children
Date
THIS LINE IS FOR CNH KIWANIS FOUNDATION USE ONLY
Applicant #
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. (Obtain from club secretary or district dues report)
Current club membership? # of years in CNH/KIWIN’S Key Club?
What year was this club chartered? Total # of CNH/KIWIN’S Key Club service hours?
CNH/KIWIN’S KEY CLUB SERVICE 60% of your score Indicate service completed as a CNH/KIWIN’S Key Club member, projects chaired, service projects organized, events attended, offices held, etc. Indicate only the top twenty (20) service projects that you completed as a CNH/KIWIN’S Key Club 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 Recruited 40+ members to volunteer; coordinated on site assignments Mentored two 7th grade students in math & science
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 CNH /KIWIN’S Key Club member. Example: Name of the project or event Key Club International Convention Kiwanis Club of Endor
Date (list multiple dates together)
2010/ 2011/ 2012 Senior Year
Describe your role and/or contribution to the project or event Attended Tour & ICON; delegate each time; Social Media Team volunteer Two per month; gave club report to Kiwanis & Kiwanis report to club
Your activities:
Indicate up to your top ten (10) offices or positions held and up to your top ten (10) honors received as a CNH/KIWIN’S Key Club member. Indicate whether office positions are elected or appointed positions. Example: Leadership Positions Held Name of the office or position Division 100 Lt. Governor PTP Car Wash 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 CNH/KIWIN’S Key Club) 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 CNH/KIWIN’S Key Club. 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 Sports Editor Violin, 3rd chair; Viola, 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 activities 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 Taught 2nd grade classes each week YMCA summer camp counselor; Crafts Instructor