TECHNICAL
AND COMMUNITY
Rotary Club of Los 2016
Angeles CAREER
/ LAUSD Beyond
the Bell Branch / Partnership
Project
COLLEGE
SCHOLARSHIP APPLICATION
Rotary Club of Los Angeles / LAUSD Beyond the Bell Branch / Partnership Project
Due February 19, 2016
The Rotary Career Technical and Community College Scholarship Application is for scholarships for $1,000 and is available for
students interested in a Vocational program or a Community College program. Students must have at least 2.85 GPA to qualify
for this application. Please Note: If you plan to attend a four-year college in the fall of 2016, do not use this application. Use our
standard Rotary College Scholarship Application available on our Rotary web site: www.rotaryla5.org
Procedure for Student:
1.
Complete each section of this application.
2.
Include the following attachments with your application, organized in numerical order (see the list below) and with the
appropriate number and your last name marked with a heavy black ink pen in the lower right hand corner of each page.

Parent financial information / tax return

Essay (see page 4)

Short Answer (see page 4)

Letters of Recommendation from a teacher, counselor, career advisor or employer (see page 5)

Certificated Transcript (Request from Counselor – see page 5)
To be completed by the student:
Name _______________________________________________________________________________________
High School:_____________________________________ # of Years Attended This School_________________
If you have attended this high school less than 3 years, name other high schools attended:
____________________________________________________________________________________________
Home Address________________________________________________________________________________
City/State/Zip_________________________________________________________________________________
Phone____________________________________ Email______________________________________________
Student Last Name: ________________________________
Return this page as part of your application 1
Rotary Club of Los Angeles / LAUSD Beyond the Bell Branch / Partnership Project
Community Service Experiences
Describe the major community service activities in which you have participated during the past four years. Choose activities that
have had the greatest impact on you or your community. Be specific about your reasons for participating in these activities and
indicate your level and length of participation in each activity. Use an additional page if needed.
Community Service Activity
Reason for Participation / Impact on You
Length & Level of Participation
School Activities, Awards and Honors
List major school activities in which you have participated during the past four years including any offices you have held. (For
example: school clubs, student government, yearbook, sports, cheer, band, choir, volunteer work, etc).
*S - senior, J - junior, S - sophomore, F - freshmen
School Activity, Awards, Honors
Year of Participation
F
S
J
S
F
S
J
S
F
S
J
S
F
S
J
S
F
S
J
S
Offices / Awards / Honors
Student Last Name: ________________________________
Return this page as part of your application 2
Rotary Club of Los Angeles / LAUSD Beyond the Bell Branch / Partnership Project
Work or Intern Experience
Describe any work or intern experiences during the past two years. Use an additional page if needed.
Employer
Position
Hours Per Week
Rate of Pay Hr/Wk/Mo
Length of Employment
Family Information
Father's Name:
Occupation:
Mother's Name:
Occupation:
Number of children in your family __________________
Number of siblings in college in the upcoming academic year: ____________________________________
Parents’ combined annual income last year (2015): $ ___________________________________________
Has any member of your immediate family attended a college or university?
______yes
______no
Has any member of your immediate family received a college degree?
______yes
______no
Attachment: A copy of applicant’s parents 2014 or 2015 Federal Income 1040 Tax Form.
Note: If your parents did not file a Federal Income Tax Return in either 2014 or 2015, please submit a letter, signed by the
parent, explaining why returns were not filed. This letter should also include the amount of your parents’ 2014 or 2015 combined
income. All financial information submitted is kept confidential.
Student Last Name: ________________________________
Return this page as part of your application 3
Rotary Club of Los Angeles / LAUSD Beyond the Bell Branch / Partnership Project
Post Secondary Education
List the top one or two community colleges, occupational centers or accredited career technical centers/institutes that you are
considering attending. Note: Do not list a four-year college.
1. ___________________________________________2. _________________________________________________
What do you plan to study? __________________________________________________________________________
Personal Essay and Short Answer Questions:
Type your essay and short answer on separate pages, double-spaced, Times New Roman, Size 12 Font.
Personal Essay (Limit to two pages)
Describe your career goal. Explain how a significant accomplishment or challenge in your life has influenced your career
choice.
Short Answer Question (Limit to one and one-half pages)
Topic: How do your community service efforts relate to what Rotary does?
The Rotary ideal of Service Above Self means that community service and helping others should be an important part of your
everyday life. Visit www.rotaryla5.org and click on “Service Projects” in the top bar for more information about the Los Angeles
Rotary Club’s Service Projects. When writing your answer, consider the following:
The Objectives of Rotary
1.
The development of friendship as an opportunity for service to others.
2.
High ethical standards in business and professions, the opportunity to serve society. For students, consider examples
from your volunteer activities, including church volunteer activities, school fundraisers, performance activities, tutoring
or mentoring of younger students, community cleanups and other community service activities like advocating for the
homeless, elderly and animal rights. How do these activities fit into your code of conduct?
3.
The application of the “ideal of service” in each Rotarian's personal, business, and community life. For students, think
about your position and the extent of your involvement in volunteer services. Have you been part of a leadership
development program like RYLA, LAUSD’s Beyond the Bell’s Take Action Ambassadors Program, SOSMentor
Shaping Our Students or other leadership-training program(s) where you carried out a number of responsibilities
related to a community service project? Also consider participation and leadership in ROTC, Band, Decathlon, Debate,
Music, Art or Theater. If possible, include statistics related to number of activities/events.
Student Last Name: ________________________________
Return this page as part of your application 4
Rotary Club of Los Angeles / LAUSD Beyond the Bell Branch / Partnership Project
Letters of Recommendation
Please submit two Letters of Recommendation by a counselor, teacher or mentor. Please ask a person who knows you well
and can speak to your accomplishments and personal goals for schooling beyond high school.
To be completed by the College Counselor, Career Advisor, Teacher or Employer:
Please submit an official transcript copy with this application.
The Grade Point Average (GPA) reflected on this student’s transcript is______________________________________
________________________________________________
_____________________________________________
Printed Name: College Counselor or Career Advisor
Signature: College Counselor or Career Advisor
Incomplete or late applications will not be accepted. Application deadline is Tuesday, February 19, 2016.
Please note: all applications must be received in the Los Angeles Rotary office by 5:00 p.m.
Mail application to:
Rotary Club of Los Angeles
523 W. 6th Street, Suite 718
Los Angeles, CA 90014
Attn.: Robert Donahue, Scholarship Chair
A digital copy of this scholarship application is available at www.rotaryla5.org. See the Scholarships drop down menu.
Questions? Email dr.robertdonahue@gmail.com
Student Last Name: ________________________________
Return this page as part of your application 5