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Sponsored Circle K District Scholarship
Philosophy
This scholarship is designed to provide recognition and financial assistance to individual members of Circle K clubs who have excelled in Circle K activities within this district.
Award Amounts
The amounts of the scholarships are: Bob Andrews $1,500, Gene OBrian $1,500, Chuck Clutts $1,500, Pat Maloney $1,500, Roy E Fritch Kiwanis International Foundation Matching $1000.
Qualifications
Applicants must be a member of a Circle K and be in good standing with their home club, district, and international
Applicants must meet the institutions minimum standards for enrollment during the academic year in which the scholarship is issued.
Applicants must be enrolled and in good standing with the institution to which the scholarship will be paid.
Application Procedures
All applicants must submit the following:
The application form.
An essay addressing the question how Circle K enhanced my leadership skills. (This essay should be limited to two double-spaced, typed pages).
One (1) letter of recommendation from a Kiwanian.
One (1) letter of recommendation from a Circle K member.
A letter or verification concerning the students status from the Dean of Students/Registrar.
All of the above must be included with the application to be considered.
The application, essay, and letters listed above must be submitted to Pacific Northwest Kiwanis Foundation Board Member Dick Rust at 4707 Black Lake-Belmore Rd. SW #20, Olympia, WA 98512. The application must be received no later than January 28, 2012.
Other Information
All application materials received by the Pacific Northwest Kiwanis Foundation shall become its property and will not be returned.
The Pacific Northwest Kiwanis Foundation Board reserves the right not to make an award if, in the boards judgment, there are no qualified applicants.
Application
Pacific Northwest Kiwanis Foundation Circle K Scholarship
Please type in each field. You may hit tab to advance t o t h e n e x t f i e l d i f y o u w i s h .
N a m e ( L a s t , F i r s t , M i d d l e ) : F O R M T E X T , F O R M T E X T , F O R M T E X T
T e l e p h o n e : ( F O R M T E X T ) F O R M T E X T - F O R M T E X T
C u r r e n t M a i l i n g A d d r e s s :
F O R M T E X T
C i r c l e K N u m b e r : F O R M T E X T
E m a i l A d d r e s s : F O R M T E X T
S o c i a l S e c u r i t y o r S o c i a l I n s u r a n c e N u m b e r : F O R M T E X T
S c h o o l I D N u m b e r : F O R M T E X T
D a t e o f B i r t h ( M M / D D / Y Y ) : F O R M T E X T / F O R M T E X T / F O R M T E X T
G e n d e r ( p l e a s e c h e c k ) : F O R M C H E C K B O X M a l e F O R M C H E C K B O X F e m a l e
G r a d e P o i n t A v e r a g e ( o n a 4 . 0 s c a l e ) : F O R M T E X T
I n s t i t u t i o n : F O R M T E X T
A d d r e s s o f I n s t i t u t i o n :
F O R M T E X T
N a m e a n d A d d r e s s o f I n s t i t u t i o n s F i n a n c i a l A i d D i r e c t o r :
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N a m e a n d A d d r e s s o f S c h o o l N e w s p a p e r :
F O R M T E X T
N a m e o f C i r c l e K C l u b : F O R M T E X T
Y e a r i n S c h o o l : F O R M T E X T
T i m e I n v o l v e d i n C i r c l e K : F O R M T E X T Y e a r s F O R M T E X T M o n t h s
N a m e o f P a r e n t s / G u a r d i a n : F O R M T E X T
A d d r e s s o f P a r e n t s / G u a r d i a n :
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P l e a s e l i s t a n y a c t i v i t i e s a n d o r g a n i z a t i o n s o u t s i d e o f C i r c l e K i n w h i c h y o u a r e i n v o l v e d :
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L i s t a l l C i r c l e K o f f i c e s a n d c o m m i t t e e p o s i t i o n s y o u h a v e h e l d ( i n c l u d e t h e y e a r s s e r v e d ) :
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Club Fundraisers: FORMCHECKBOX 0-24% FORMCHECKBOX 25-49% FORMCHECKBOX 50-74% FORMCHECKBOX 75-100%
Club Socials: FORMCHECKBOX 0-24% FORMCHECKBOX 25-49% FORMCHECKBOX 50-74% FORMCHECKBOX 75-100%
How many new (prospective) members did you bring to club meetings? FORMTEXT
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Kiwanis Club or
Faculty Advisors ______________________________________ Date:_____________
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