2009 Key Club Scholarship Booklet

       Key Club International  Scholarship Booklet

     

Key Club International 2009 Scholarship Program This booklet contains information about Key Club International (KCI) scholarships and the District Matching Scholarship Program. Students applying for the KCI scholarships must do so through the district scholarship application process or submit them directly as indicated. If the district does not have its own application form, the enclosed two-page application form may be used. Districts will then send to Key Club International, one finalist for each Key Club scholarship we offer. A Key Club committee at the International Office will determine scholarship winners. All scholarships are provided as cash awards in the form of a check issued to the college or university and the student. This check is sent directly to the college or university for deposit into the student’s account and, most likely, will require the student to endorse the check. Checks are disbursed in August from the Kiwanis International Foundation. A copy of the letter and check is sent to the recipient’s home address. Recipients will be announced at the 2009 Key Club International Convention and posted on the Key Club International Web site. All questions regarding this program should be directed to the Key Club International youth funds and scholarship specialist, 1-800-549-2647, ext. 244. 2009 Key Club International scholarships (amounts in US dollars) • • • • •

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Key Club International Youth Opportunities Fund Scholarship: Two $4,000 four-year scholarships awarded in $1,000 increments. Funded by Key Club International reserve investment earnings. Himmel Scholarship: One $500 scholarship. Funded by family and friends of Harry S. Himmel, deceased president emeritus of the Kiwanis International Foundation. Robert Thal Scholarship: One $500 scholarship. Funded by contributions from friends and family of deceased past Florida District Governor Robert Thal. Stephen Sapaugh Memorial Scholarship: One $4,000 scholarship awarded in $1,000 annual increments. Funded by an endowment fund established in memory of deceased Key Club member Stephen Sapaugh. Cunat International Scholarship: One $2,500 scholarship provided by Kiwanis International Past President Brian Cunat and First Lady Miki. Based on leadership in his or her line of study, regardless of grade point average or financial need. This application is included at the back of this packet and must be submitted separately to the address provided. Linda Canaday Memorial Scholarship: At least one $1,000 scholarship provided by family and friends of Linda Canaday, 2008-09 First Lady—and wife of Kiwanis International President Don Canaday—who passed away earlier this year. Based upon leadership and service, regardless of financial need. This application is included at the back of this packet and must be submitted separately to the address provided. Donald F. Nix Scholarship: Two $1,500 scholarships provided by the family of Donald F. Nix, a deceased Kiwanian from the Illinois-Eastern Iowa District. Because the endowed scholarship fund honors a gentleman with a physical disability that presented unique challenges in everyday life, it is preferred that recipients face some type of physical limitation that provides special challenges. Recipients must be Key Club members from the Illinois-Eastern Iowa District. It is preferred that recipients attend an applicable educational institution within the state of Illinois. This application is included at the back of this packet and must be submitted separately to the address provided. To apply for these scholarships, you must submit either your District Scholarship Application with the KCI cover sheet, or the KCI Scholarship Application through your district by its deadline!

2009 KEY CLUB INTERNATIONAL SCHOLARSHIP To be attached to district scholarship application Submit with district scholarship application Name

Key Club member number First

Middle

Last

Permanent address Street address City

State/province

Home phone with area code

/

Postal code

Nation

E-mail address

Parents’ names College Key Club district Key Club International scholarships I am applying for (check all scholarships for which you want to be considered): Key Club International Youth Opportunities Fund Scholarship Himmel Scholarship Stephen Sapaugh Memorial Scholarship Robert Thal Scholarship District Matching Scholarship Other: UNIVERSITY INFORMATION I have not finalized my decision as to which school I will be attending in the fall. I will be attending the following school. (The scholarship check will be sent directly to the school’s Financial Aid or Scholarship Office.) Please secure the address of this office. University name University identification number Office check to be mailed Address Campus address City

State/province

Zip/Postal code

Nation

Zip/Postal code

Nation

HOMETOWN NEWSPAPER INFORMATION Name of hometown newspaper Address Campus address City

State/province

Signature I verify that this information is accurate, Applicant Date

Printed name

Scholarships available to Key Club members by other organizations: •

Arizona State University Leadership Scholarship (LSP). Recognizes outstanding high school graduating seniors who have achieved excellence in leadership. Established in 1977 to aid in the growth of student leaders on campus. Students in the program participate in CED 194, a leadershipdevelopment course; one-on-one mentoring by an ASU staff member; monthly meetings with all current ASU LSP students; social activities, such as a weekend retreat; community service; and networking with LSP alumni. Students may use the scholarship for tuition and fees, housing, and other educational expenses. The nonresident award is a $17,500 annual scholarship, renewable for three additional years. Four out-of-state seniors, who must have been active members of Key Club or another nationally recognized leadership organization, with a 3.25 unweighted grade point average will be selected. To apply, you must complete the application and submit it with: • A copy of your high school transcripts with ACT/SAT scores. • A list of high school activities (include brief description of organization, dates of participation and leadership positions held), list of community service and volunteer projects (include total hours and dates of participation). • A list of honors, awards and special leadership programs attended (i.e. classes, workshops, conferences). You also must answer two of the following three questions in essay format (a maximum of two pages per answer): 1) If you could ask any leader (living or dead) three questions, who would you ask, what would the questions be, and why? 2) In your opinion, who is more effective and why: one who leads by outward action or one who leads by silent example? Which type of leader are you? 3) If you were asked to give a speech to your peers concerning your “passion” in life, what would your speech sound like? Two letters of recommendation (if you are a nonresident, one must be from Key Club sponsor) also are required. Submit materials by December 5, 2008 to: Leadership Scholarship Program, Undergraduate Admissions, Attention: Kimberly Jones, Arizona State University, PO Box 870112, Tempe, Arizona 85287-0112. For more information, call 1-480-965-3040 or visit www.asu.edu/admissions/lsp.

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DePauw University Bonner/Wright Scholarship: Two scholarships valued at more than $13,000. Each recipient will receive an annually renewable $10,000 John Ellis Wright Award in addition to a Bonner Scholarship valued at up to $3,600. The two Key Club members will be selected for the DePauw University Bonner/Wright Scholarships on the basis of academic achievement, commitment to community service, and leadership. Recipients are expected to maintain a good academic standing and become actively involved in community service by joining the DePauw University Circle K Club. Students receive a stipend during both the school year and summer to support them in their community service. For information, contact: Sarah Ryan, director, the Bonner Scholars Office, DePauw University, 500 E. Seminary Street, Greencastle, Indiana 46135; phone, 765-658-4620; e-mail, [email protected]. Application deadline is February 1, 2009. The application is also available at http://www.depauw.edu/admission/applying/forms/bonner/_app.asp

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Wittenberg University Key Club International Scholarship: In addition to merit-based scholarship programs, Wittenberg recognizes the unique experiences gained through participation with Key Club International. Applicants who have been involved with Key Club International will be awarded a Key Club International Special Recognition Award of $1,000, in addition to any merit scholarship they receive. Selection is based upon acceptance to Wittenberg University, academic achievement,

commitment to community service, involvement in Key Club, and extracurricular activities. The Wittenberg University Key Club International Scholarship was created in 2002 to recognize Key Club members’ commitment to community service and leadership. For more information about this scholarship, contact assistant director of admission, Key Club International Scholarship, Wittenberg University, PO Box 720, Springfield, Ohio 45501; phone, 877-206-0332; e-mail, [email protected]. The application for free admission is available online at www.wittenberg.edu. There is no separate application required for this scholarship. Application deadline is February 1, 2009. •

Lindenwood University Key Club International Scholarship: Unlimited number of awards given in the amount of $5,000 (and renewable annually for four years, or up to completion of undergraduate degree). Selection is based upon acceptance to Lindenwood University, academic achievement, commitment to community service, involvement in Key Club, and extracurricular activities. Students must meet the minimum requirement for merit based scholarship assistance (20 ACT and 2.5 high school or 2.0 transfer college grade point average). Recipients are expected to maintain a good academic standing and become actively involved in community service by joining the Lindenwood University Circle K Club. For more information about this scholarship program, contact Joanna Finch, Circle K faculty advisor, Key Club International Scholarship, Lindenwood University, 209 S. Kingshighway, St. Charles, Missouri 63301; phone, 636-949-4931; e-mail, [email protected]; Web site, http://www.lindenwood.edu. Application deadline is February 1, 2009.

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Kappa Alpha Order’s “joinKA.com Scholarship”: Two scholarships for Key Club members valued at $250 each. The two recipients will be selected for the scholarship based on goals similar to Kappa Alpha Order: scholarship, community service, leadership, and personal development. For information about this scholarship program, contact Jesse Lyons, director of chapter development, PO Box 1865, Lexington, Virginia 24450; phone, 540-463-1865; e-mail [email protected]. Application deadline is May 1, 2009. The only step to apply is to complete the application included at the back of this packet, and submit it separately to the address provided.

Kiwanis International Foundation/Key Club district matching scholarships offered to participating districts Application deadline determined by each district. The Kiwanis International Foundation and Key Club International have designed a scholarship program to recognize Key Club members who have excelled in leadership and have provided service to others. Financial need is not a factor in this award. Each winner will receive a one-time $1,000 award (unless a district changes the award amount). Districts are eligible to receive up to 10 matching scholarships based on the amount of Kiwanis clubs participating in the Annual Club Gift Campaign with the Kiwanis International Foundation. Interested students need to contact their district administrator (or representative, listed below) to determine the district’s participation in the 2009 program. Applications for this scholarship are mailed directly to the district representative, as indicated below or directed through the district. Each district determines its own deadline. Key Club International Board members and Key Club district governors are not eligible for the district matching scholarship program. Each district’s Key Club board is to determine the procedure to select the district scholarship winner(s). The district administrator is to forward the winning recipient form and matching funds to the Kiwanis International Foundation by May 22, 2009.

The Kiwanis International Foundation/Key Club district matching scholarship recipients will be notified by the Kiwanis International Foundation, and their names announced at the 2009 Key Club International Convention and posted on the Key Club International Web site. All scholarships are provided as cash awards in the form of a check issued to the college or university and the student. This check is sent directly to the college or university for deposit into the student’s account and most likely requires the student to endorse the check also. Checks are disbursed in August. Who is qualified for the Kiwanis International Foundation/district matching scholarship program (these are the same qualifications for the Key Club International Scholarships)? A Key Club member who: Has been an active Key Club member for two years in good standing. Has paid dues and appears on the roster on file at Key Club International. Is a graduating high school senior Is a college-, university-, technical-, or vocational school-bound student. Has a grade–point average of at least a “B” or the equivalent of a 3.0 on a 4.0 scale. Has attached an official high school transcript with an explanation of the grading system utilized. Submits the application to the Key Club district administrator by the deadline established by the district. For further information, contact the administrator. 2008-2009 District administrators or scholarship contacts ALABAMA – Bob Bottsford, 6326 Rock Mountain Lake Road, McCalla, Alabama 35111; phone, 205424-8331 or 426-2911; cell, 205-541-3293; fax, 205-425-8754; e-mail [email protected] Deadline for application: March 1, 2009 CALIFORNIA-NEVADA-HAWAII –Send applications to: Bruce Hennings, California-Nevada-Hawaii District Office, 8360 Red Oak Street #201, Rancho Cucamonga, California 91730; phone, 877-597-1770, ext. 105; fax, 510-550-2811; e-mail, [email protected] Deadline for application: February 20, 2009 CALIFORNIA-NEVADA-HAWAII KIWIN’S –Send applications to: Bruce Hennings, California-NevadaHawaii District Office, 8360 Red Oak Street #201, Rancho Cucamonga, California 91730; phone, 877597-1770 ext. 105; fax, 510-550-2811; e-mail, [email protected] Deadline for application: February 20, 2009 CAPITAL – Joe Stankus, 1229 Bellevue Avenue, Richmond, Virginia 23227; phone, 804-564-5668; e-mai, [email protected] Deadline for application: April 1, 2009 CAROLINAS – J. Scott Johnson, 2008 Pinecrest Drive, Greensville, North Carolina 27858; home phone, 252-355-0644; cell, 704-968-1051; e-mail, [email protected] Deadline for application: March 1, 2009 EASTERN CANADA –Ken Hanson, 8 Ambleside Ave., Toronto, Ontario M8Z 2H6 Canada; phone, 416252-6250; e-mail, [email protected] Deadline for application: March 1, 2009 FLORIDA – Beverly Baird, 111 Pine Oak Drive, Palatka, Florida 32177; phone, 386-546-3608; e-mail, [email protected] Deadline for application: March 1, 2009

GEORGIA – Doug Westmoreland, 127 Meadowridge Drive, Mount Airy, Georgia 30563; phone, 706499-2107; e-mail, [email protected] Deadline for application: February 17, 2009 ILLINOIS-EASTERN IOWA – Bob Hall, 28 Candy Lane, Murphysboro, Illinois 62966-2953; phone, 618687-2205; e-mail, [email protected] Deadline for application: January 31, 2009 INDIANA – Send applications to Susan Walker, executive director, Kiwanis Indiana District, 8060 Knue Road, Suite 127, Indianapolis, Indiana 46250; phone, 317-578-0857; e-mail, [email protected] Deadline for application: March 1, 2009 JAMAICA – Navara Dennis, Coleraine Street, Oracabessa PO, St. Mary, Jamaica W.I.; phone, 876-9753371; e-mail, [email protected] Deadline for application: March 1, 2009 KANSAS – Send applications to Bob Hottman, 103 W. 8th, Harper, Kansas 67058; phone, 620-896-2575; e-mail, [email protected] Deadline for application: February 1, 2009 KENTUCKY-TENNESSEE – Steve Phillips, PO Box 188, Flintstone, Georgia 30725; home phone, 706-8202564; cell, 423-309-0765; e-mail, [email protected] Deadline for application: Must be received by mail by March 9, 2009, or submitted during the district convention March 13, 2009 LOUISIANA-MISSISSIPPI-WEST TENNESSEE –Send Application to Charles H. Ford, executive director, Louisiana-Mississippi-Tennessee Kiwanis District Office (5319-B Didesse Drive) PO Box 14026, Baton Rouge, Louisiana 70898-4026; business phone, 225-766-9323; e-mail, [email protected] Deadline for application: January 31, 2009 MICHIGAN – Greg Smith, 4260 Sandy Creek, Shelby Township, Michigan 48316; phone, 586-803-1759; e-mail, [email protected] Deadline for application: February 13, 2009 MINNESOTA-DAKOTAS – Mary Beth Townsend, 7508 Jasmine Avenue South, Cottage Grove, Minnesota 55016; home phone, 651-459-8977; e-mail, [email protected] Deadline for application: February 16, 2009 MISSOURI-ARKANSAS – Jim Zuroweste, 120 Monroe, Troy, Missouri 63379; home phone, 636-4627757 e-mail [email protected] Deadline for application: February 1, 2009 MONTANA – Ed Leland, 2221 Rosewyn, Billings, Montana 59102-2147; home phone, 406-652-5625; email, [email protected] Deadline for application: March 9, 2009 NEBRASKA-IOWA – TJ Tjaden, Box 101, Webster City, Iowa 50595-0101; home phone (in evening), 515832-3192; e-mail, [email protected] Deadline for application: Must be received in time to be judged on first day of district convention, March 27, 2009

NEW ENGLAND – George Whitney, PO Box 467, Hardwick, Vermont 05843-0467; home phone, 802-4726240; e-mail, [email protected] Deadline for application: March 1, 2009 NEW JERSEY – Barrie Werfel, 36 Williamsburg Dr., Roseland, New Jersey 07068-1215; phone, 973-2282743; cell, 973-985-4096; e-mail, [email protected] Deadline for application: March 1, 2009 (Use NJ application found on www.njkeyclub.org) NEW YORK – Andy Lowenberg, 92 Budenos Dr., Sayville, New York 11782-2228; phone, 631-567-4283; email, [email protected] Deadline for application: March 1, 2009 OHIO – Jeff Eble, 6757 Vineyard Haven Loop, Dublin, Ohio 43016; phone, 330-441-2527; e-mail, [email protected] Deadline for application: March 1, 2009 PACIFIC NORTHWEST – John Jay, 8211 NE Blakely Ct. W., Bainbridge Island, Washington 98110; phone, 206-842-7592; e-mail, [email protected] Deadline for application: February 1, 2009 PENNSYLVANIA –Robert Bagans, district administrator, 320 Nicholas Place, Sewickley Pennsylvania 15143-1032; phone, 412-741-5455; e-mail, [email protected] Deadline for application: February 13, 2009 ROCKY MOUNTAIN – David Harris, 1641 S. Parfet Court, Lakewood, Colorado 80232-6130; phone, 303989-7994; e-mail, [email protected] Deadline for application: Applications for the RMD District Matching Scholarships must be received by the district administrator by 7 p.m., April 3, 2009. They may be sent to his house or hand delivered at the district convention. Contact him for district criteria and guidelines. SOUTHWEST – Vickie Biehn, 3172 Horseshoe Canyon Lane, Lake Havasu City, Arizona 86406; phone, 928-453-5051; e-mail, [email protected] Deadline for application: Postmarked by March 1, 2009 TEXAS-OKLAHOMA –Mail applications to Chuck O’Toole at the Texas-Oklahoma District Office, 624 Six Flags Dr. Ste. 265, Arlington, Texas 76011-6342; phone, 817-640-7711; e-mail, [email protected] Deadline for application: February 27, 2009 UTAH-IDAHO – Marvin D. Chamberlain, Utah-Idaho Kiwanis District and District Foundation treasurer, PO Box 25, Twin Falls, Idaho 83303-0025; home phone, 208-734-8321; work phone, 208-734-4244 work; email, [email protected] Deadline for application: April 9, 2009. (The district has its own application form and instructions that are mailed in January, along with the district convention packet, to each faculty advisor.) WEST VIRGINIA – Richard Yurko, PO Box 2190, Clarksburg, West Virginia 26302-2190; phone, 304-6248103; e-mail, [email protected]. Deadline for application: March 11, 2009 (West Virginia has its own application that is sent out along with District Convention materials.)

WISCONSIN-UPPER MICHIGAN – Kathy Vorpahl, 531-A Park Street, Combined Locks, Wisconsin 54113; cell, 920-475-0500; e-mail, [email protected] Deadline for application: February 22, 2009

Key Club International scholarship application Submit to Key Club district

Use this form if district does not have a form. Submit only one application per student. Check all scholarships for which you want to be considered. Key Club International Youth Opportunity Fund Scholarship Himmel Scholarship Stephen Sapaugh Scholarship Robert Thal Scholarship District Matching Scholarship Other: Name

Key Club member number First

Middle

Last

Birth date (mo/day/year)

Gender: Female

Male

Permanent Address Street address City

State/province

Home phone with area code Grade point average/scale Parents’ names High school Key Club faculty advisor Advisor phone with area code

Postal code

/

Nation

E-mail address Key Club district

/

E-mail address

UNIVERSITY INFORMATION I have not finalized my decision as to which school I will be attending in the fall. I will be attending the following school: (The scholarship check will be mailed directly to the school’s Financial Aid or Scholarship Office or applicable office. Please secure the address of this office.) University name: To which office the check should be mailed: Address: Campus address City

State/province

Phone number with area code / HOMETOWN NEWSPAPER INFORMATION Name of hometown newspaper Address:

Postal code

Nation

Postal code

Nation

E-mail address

Street address City

State/province

E-mail address

SIGNATURES Applicant Key Club advisor Parent signature:

Printed name Printed name Printed name

Key Club offices and leadership events (Elected or appointed positions on the club, district or international level. Also list any district/international conventions, training conferences, or leadership events attended.):

Campus organizations and activities:

Religious and community activities:

Honors, awards and special recognition:

Attach two recommendation letters that describe your leadership ability, one from a Kiwanis club member or your Key Club faculty advisor, and one from a community or religious leader. The reference letters must be no more than two pages in length, and they must be original letters that are dated and signed by your references. Attach a certified a copy of your official high school transcript with an explanation of the grading process used at the school.

Scholarship applications must be postmarked by your district’s deadline, and mailed to your district’s representative.

Cunat International Scholarship While serving as 1992-93 governor of the Illinois-Eastern Iowa District in, Brian Cunat and his wife, Miki, established this scholarship to recognize and support Kiwanis-family members who were setting out to make a difference in people’s lives as they worked their way through school. The Cunats have been believers in setting goals, staying the course, and accomplishing goals. Life goals should be not only self serving, but include the concept of helping others and making the world a better place for all. While serving as 2001-02 Kiwanis International President, Brian and First Lady Miki expanded the scholarship program to include other parts of the world. Their love for children and young adults, and their beliefs that our future is in their hands, motivates them to fund these scholarships. Together we can “build today for tomorrow’s dreams.” One $2,500 scholarship for a college-attending Key Club International member. Name First

Middle

Last

Permanent Address Street address City

State/province

Home phone with area code

-

Zip/postal code

Gender: Female

Country

Male

Parents’ names E-mail address Grade point average/Scale

Major

University planning to attend To which office the check should be mailed: Address: Campus address City

State/province

Phone with area code

-

Zip/postal code

Country

E-mail address

1. Please list Kiwanis-family involvement (K-Kids, Builders Club, and Key Club).

2. Other organizations and activities you have been involved with:

3.

Attach a 200-word essay describing how your studies will help you achieve your goals, while benefiting the lives of others.

4.

Attach two letters of reference originally signed and dated and no more than two pages in length that describe how you are beginning this “life to benefit others.” The letters should be from a Kiwanis or faculty advisor to the Key Club, and a fellow Key Club member. Required signatures Applicant:

Printed name

Kiwanis advisor:

Printed name

This scholarship application must be submitted by April 15, 2009 directly to: Brian and Miki Cunat, 5400 W. Elm Street, Suite 110, McHenry, Illinois 60050

Linda Canaday Memorial Scholarship Application The Linda Canaday Memorial Scholarship is funded by family and friends in memory of Kiwanian and 2008-09 First Lady Linda, wife of Kiwanis International President Don Canaday, who passed away earlier this year. Applicants must have been a two-year member of Key Club in good standing, have a 3.0 grade point average (or its equivalent on a 4.0 scale), submit this completed application, along with two letters of reference, and provide an official high school transcript with an explanation of the applicable grading system. The address to submit this packet is at the end of this application. Gender

Name

Female

Home address Street City

State/province

Home phone with area code

Postal Code

/

Grade point average/scale

E-mail address Class rank/class size

Parents’ names High school

Key Club district

Birth date (mo/day/year) SIGNATURES Applicant

Printed name

Key Club faculty advisor

Printed name

Applicant’s parent

Printed name

Key Club offices and leadership events attended:

Country

Male

Key Club service work completed:

High school activities, leadership experience:

Community activities, leadership experience:

Awards and honors received:

Provide two letters of recommendation that describe your leadership abilities, one from your Key Club faculty or Kiwanis advisor, and the other from a community or religious leader. The letters shall be no more than two pages in length and shall be original letters, dated and signed by the references. Submit this application received by April 1, 2009 to Gayle Webb, Linda Canaday Memorial Scholarship, Kiwanis International Foundation, 3636 Woodview Trace, Indianapolis, Indiana 46268

Kappa Alpha Order’s “joinKA.com Scholarship” 2009 Application Name

First

Middle

Present address

Street address

City

State/province

Telephone with area code

/

Mailing address after 6/1 (if different)

City

Postal code

Nation

E-mail address Street address

State/province

Telephone with area code Age

Last

/

Postal code

Nation

Gender: Female

Male

Date of birth (mo/day/year)

Institution in which you expect to enroll for Fall 2009: Have you already been admitted to the above institution? What type of degree will you be working toward? [ ] undergraduate List extracurricular activities in high school.

(next)

[ ] professional

What are your plans for the future?

List summer and academic-year jobs you’ve had in the past four years.

I hereby certify that all information in this application is true and accurate. I understand that forgery of any signature or intentional misrepresentation herein will result in the disqualification of my application and possible disciplinary proceedings. Further, I understand that deviation from the academic plans outlined herein may result in a review by the scholarship committee of any grant awarded.

Signature of applicant: Date: Questions about this scholarship may be directed to Jesse Lyons, director of chapter development, Kappa Alpha Order, PO Box 1865, Lexington, Virginia 24450 Phone, 540-463-1865; Fax: 540-463-2140; e-mail, [email protected] Application deadline: Submit to Kappa Alpha Order at the address above no later than May 31, 2009.

Donald F. Nix Scholarship This scholarship honors Donald F. Nix, a former Illinois-Eastern Iowa District Kiwanian whose physical disability presented challenges in everyday life. It is preferred that the recipients of this scholarship face some type of physical limitation that provides special challenges. The recipients shall have been a member in good standing of Key Club International in the IllinoisEastern Iowa District, and it is preferred that the recipients attend an applicable educational institution within the state of Illinois. The recipients shall be graduating high school seniors enrolled in an accredited university, college, technical school, or vocational school. Recipients may also be currently attending one of these referenced institutions. Two $1,500 scholarships.

Name First

Middle

Last

Permanent address Street address City

State/province

Home phone with area code

-

Zip/postal code

Gender: Female

Country

Male

Parents’ names E-mail address Grade point average/scale

Major

University planning to attend To which office the check should be mailed: Address:

Campus address

City

State/province

Phone with area code

/

Zip/postal code

Country

E-mail address

1. Please list Kiwanis-family involvement (K-Kids, Builders Club, Key Club, including offices and leadership events attended:

2. Other organizations and activities you have been involved with (include offices held):

3. Key Club service work completed (include number of hours completed):

4. Community activities completed (include leadership experience):

5. Awards and honors received:

Attach two letters of reference originally signed and dated and no more than two pages in length describing how you have overcome your adversity/challenges to succeed. The letters should be from a Kiwanis or Faculty Advisor to the Key Club, and a community or religious leader.

Required signatures Applicant:

Printed name

Kiwanis advisor:

Printed name

This scholarship application must be received by April 1, 2009 directly to: Gayle Webb, Donald F. Nix Scholarship, 3636 Woodview Trace, Indianapolis, Indiana 46268 November 2008 Key Club International A Kiwanis Service Leadership Program