ABILENE KIWANIS CLUB SCHOLARSHIP

THIS YOU MUST DO:

1. Complete and return the application to Abilene High School Guidance Office.
a) Attach a transcript of your high school or post-high school work.
b) Enclose a recent wallet size picture of yourself.
2. Have three (3) persons fill our recommendation forms out and return them to:

Abilene High School Guidance Department

Attn: Kiwanis Club Scholarship
1300 N. Cedar,
Abilene, KS 67410
By: March 31st
by April 12.

PLEASE PRINT OR TYPE

APPLICATION FORM
ABILENE KIWANIS CLUB SCHOLARSHIP
ABILENE, KS 67410

RETURN TO:

Due March 31st

Abilene High School

Guidance Office
Abilene, KS 67410

A scholarship fund has been established by Abilene Kiwanis Club as a permanent

scholarship fund to provide advance education in the interest of the young people in
Abilene, Kansas. This scholarship is to be awarded to an Abilene high school senior for
an accredited school of their choice, i.e. a college or university, junior college, a trade school or
technical school.
Date ______________________________
Name______________________________________ Birthday Mo/___Day/___Year/___
Last
First
Middle
Home Address ___________________________________________________________
Fathers Name ___________________________________________________________
Place of employment ______________________________________________________
Mothers Name ___________________________________________________________
Place of employment ______________________________________________________
Number of Brothers_______Ages_____________________________________________
Number of Sisters

Ages______________________________________________

How many in college and/or post-high school courses next year?___________________

List HONORS - AWARDS - MAJOR ACTIVITIES - MEMBERSHIPS IN
ORGANIZATIONS. Attach a separate page if you wish. Be as specific as possible.
High School
Community - Past & Present
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

Describe your field of study, the institution you wish to attend and reasons for its selection.
Future plans or aims for your career and any other information which might be helpful to
the awarding committee. Attach a page if necessary.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
FINANCIAL:
What full or part-time employment have you had during high school?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Describe below any pertinent information concerning the financial obligations of your family
that would be helpful in assessing your financial needs. Please try to be specific
(extended family, medical expenses, etc.)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
REFERENCES:
Contact at least three people who can testify as to your eligibility for an award (based on
need, scholastic ability and character). High school teachers or principals, businessmen
or former employers are useful contacts. DO NOT USE RELATIVES.
NAME
POSITION
ADDRESS
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Contact the above persons and get permission to use their names. Give each of them
one of the recommendation forms and a stamped envelope addressed to:
Abilene High School Guidance Dept.
ATTN: Kiwanis Club Scholarship
1300 N. Cedar, Abilene, KS 67410.

APPLICANT

PLEASE READ CAREFULLY BEFORE YOU SIGN THIS AGREEMENT.

I understand that if I am selected for an award:

1. I shall use the money for college expenses.
2. One half of the award will be given first semester payable to the institution of your
choice.
3. I shall furnish a transcript of my grades for the first semester of school to Abilene
Kiwanis Club, before the start of the second semester. This will be necessary if I
am to receive the second portion of my award.
4. If I should decide to drop out of college or any post-high school at any time during
the first semester, I agree to repay the Scholarship Fund in full or in part, according
to the length of time attended.

__________________________________
Signature

RECOMMENDATION FOR
ABILENE KIWANIS CLUB SCHOLARSHIP
Concerning _______________________ Address _________________
The above named has applied for an Abilene Kiwanis Club Scholarship. Would
you rate the student on each of the following characteristics by placing a check
mark somewhere on the horizontal line opposite each of the eight characteristics.
Remember to compare this student to the average student. This form will be kept
in strict confidence and will only be shown to the selection committee.
1. MOTIVATION ___________________________________________
Not Motivated

Usually Motivated

Highly Motivated

2. INITIATIVE ____________________________________________
Needs Constant Pressure

Does What Is Asked

Seeks

3. INFLUENCE

AND LEADERSHIP ____________________________________________

Negative - Cooperative - Judgment Respected Makes Things Go

4.

CONCERN FOR OTHERS _______________________________________

Indifferent
Somewhat
Actively Concerned

5.

RESPONSIBILITY _____________________________________________
Unreliable-Usually dependable-Always does what they say they will do

6.

PERSONAL APPEARANCE ______________________________________

Not Concerned - Usually Look Nice - Always Concerned

7.

CITIZENSHIP ________________________________________________
Not a Good Citizen
Usually
Always A Good Citizen

8.

Your estimate of applicants future success, based on the purpose of this application
Little Success _____ Average _____ Above Average ______ Superior _____

9.

FINANCIAL NEED : Must have help ____Could use help ____No help needed ____

10.

Any additional comments you might want to make regarding the applicants financial
need and/or suitability to receive an award.
In what Capacity were you connected with this person?
Signature ___________________________ Position ________________
Address ____________________________ Date __________________
Due March 31

RECOMMENDATION FOR
ABILENE KIWANIS CLUB SCHOLARSHIP
Concerning _______________________ Address _________________
The above named has applied for an Abilene Kiwanis Club Scholarship. Would
you rate the student on each of the following characteristics by placing a check
mark somewhere on the horizontal line opposite each of the eight characteristics.
Remember to compare this student to the average student. This form will be kept
in strict confidence and will only be shown to the selection committee.
1. MOTIVATION ___________________________________________
Not Motivated

Usually Motivated

Highly Motivated

2. INITIATIVE ____________________________________________
Needs Constant Pressure

Does What Is Asked

Seeks

3. INFLUENCE

AND LEADERSHIP ____________________________________________

Negative - Cooperative - Judgment Respected Makes Things Go

4.

CONCERN FOR OTHERS _______________________________________

Indifferent
Somewhat
Actively Concerned

5.

RESPONSIBILITY _____________________________________________
Unreliable-Usually dependable-Always does what they say they will do

6.

PERSONAL APPEARANCE ______________________________________

Not Concerned - Usually Look Nice - Always Concerned

7.

CITIZENSHIP ________________________________________________
Not a Good Citizen
Usually
Always A Good Citizen

8.

Your estimate of applicants future success, based on the purpose of this application
Little Success _____ Average _____ Above Average ______ Superior _____

9.

FINANCIAL NEED : Must have help ____Could use help ____No help needed ____

10.

Any additional comments you might want to make regarding the applicants financial
need and/or suitability to receive an award.
In what Capacity were you connected with this person?
Signature ___________________________ Position ________________
Address ____________________________ Date __________________
Due March 31

RECOMMENDATION FOR
ABILENE KIWANIS CLUB SCHOLARSHIP
Concerning _______________________ Address _________________
The above named has applied for an Abilene Kiwanis Club Scholarship. Would
you rate the student on each of the following characteristics by placing a check
mark somewhere on the horizontal line opposite each of the eight characteristics.
Remember to compare this student to the average student. This form will be kept
in strict confidence and will only be shown to the selection committee.
1. MOTIVATION ___________________________________________
Not Motivated

Usually Motivated

Highly Motivated

2. INITIATIVE ____________________________________________
Needs Constant Pressure

Does What Is Asked

Seeks

3. INFLUENCE

AND LEADERSHIP ____________________________________________

Negative - Cooperative - Judgment Respected Makes Things Go

4.

CONCERN FOR OTHERS _______________________________________

Indifferent
Somewhat
Actively Concerned

5.

RESPONSIBILITY _____________________________________________
Unreliable-Usually dependable-Always does what they say they will do

6.

PERSONAL APPEARANCE ______________________________________

Not Concerned - Usually Look Nice - Always Concerned

7.

CITIZENSHIP ________________________________________________
Not a Good Citizen
Usually
Always A Good Citizen

8.

Your estimate of applicants future success, based on the purpose of this application
Little Success _____ Average _____ Above Average ______ Superior _____

9.

FINANCIAL NEED : Must have help ____Could use help ____No help needed ____

10.

Any additional comments you might want to make regarding the applicants financial
need and/or suitability to receive an award.
In what Capacity were you connected with this person?
Signature ___________________________ Position ________________
Address ____________________________ Date __________________
Due March 31