Rotary International District 5440 Scholarships
The purpose of the Rotary International District 5440 Scholarships “is to further international understanding and
friendly relations among people of different countries.” The program sponsors several types of scholarships for
undergraduate and graduate students as well as for qualified professionals pursuing vocational studies. While
abroad, scholars serve as ambassadors of goodwill to the people of the host country and give presentations about
their homelands to Rotary clubs and other groups. Upon returning home, scholars share with Rotarians and
others the experiences that led to greater understanding of their host countries. These scholarships are made
possible by the generous contributions of District 5440 Rotarians, including clubs from across Wyoming, northern
Colorado, and western Nebraska. The University of Wyoming is one of three universities in District 5440 offering
these scholarships.
In keeping with Rotary International’s Six Areas of Focus, District 5440 Scholarships will provide scholarships to
students who will be studying in one of the following six Areas of Focus:
(1) Peace and Conflict Prevention/Resolution;
(2) Disease Prevention and Treatment;
(3) Water and Sanitation;
(4) Maternal and Child Health;
(5) Basic Education and Literacy;
(6) Economic and Community Development.
There are three scholarship types available
1) Summer Study Rotary Field Study/Seminar Scholarship in the amount of $2,500.00 with an application
deadline of March 1, 2016.
2) Semester/Year Study Rotary International Scholarship in the amount of $2,500.00 with an application
deadline of March 1, 2016.
3) Semester/Year Study Rotary International Scholarship in the amount of $5,000.00 with an application
deadline of March 1, 2016.
Applicants will apply through UW on deadlines outlined above, and will be recommended to the local Rotary
Committee. The local Rotary Committee will recommend selected applicants to the District Scholarship
Committee of Rotary District 5440. The District will interview finalists and select awardees.
To qualify for the Rotary International District 5440 Study Abroad Scholarship, applicants must:
 Have at least 30 hours of undergraduate coursework or 9 credit hours of graduate coursework completed
at the time of studying abroad.
 Be a current UW graduate or undergraduate student accepted in the UW Study Abroad/International
Exchange program.
 Have a minimum GPA of 3.00 out of 4.0.
 Financial need will also be considered, as demonstrated through FAFSA or other documentation.
Rotary International District 5440 Scholarships
Name:_________________________________________ E-Mail:____________________ W#_____________
Local Address:__________________________________ Local Phone:________________________
Major: __________________________________
College hours completed:_________ GPA:_________ Expected Graduation Date:_________
Program Locale:
When will you will be abroad?
Fall
Spring
Summer
Academic Year
Year(s): 20___
Which Rotary International Scholarship are you applying for?
Summer - Field/Seminar Scholarship
Semester/Year Scholarship
Please include with your application:
(1) This application form, including the attached budget. Be sure to read the Scholarship Fact Sheet, found at
http://www.uwyo.edu/intprograms/scholarships/index.html, for additional information.
(2) A one-page statement of purpose documenting what you expect to gain from your proposed experience
abroad. Highlight the Area of Focus you will be concentrating on, and address the program objectives of
Rotary International District 5440’s program, including how your experience will increase your awareness
of and respect for cultural differences, how you expect that the Rotary ideal of “Service Above Self” will
be realized during your time abroad, how you envision your experience abroad will improve the quality of
life for the people of your home community and country, and how this experience will help you think in
the long-term about addressing the humanitarian needs of the global community.
(3) A one-page description of the intended program of study, including prospective courses and how those
courses fit into your long term academic and professional plans. Students wanting to do independent
research should outline their research design and give contact information for their project / independent
study faculty mentor.
(4) An official transcript
(5) A signed copy of the Rotary International District 5440 Terms and Conditions Form, attached below.
All material cited above should be collated into one document, and applications emailed as ONE .doc, .docx,
or .pdf file to: iposship@uwyo.edu. ONLY electronic submissions will be accepted.
Rotary International District 5440 Scholarships
Rotary International District 5440 Scholarships
Tentative Budget
Name: ________________________________________________________________
Length of time Abroad: From ________________________ to ___________________________
Destination: ______________________________________________________________________
Tuition and fees
$ _______________
Airfare (originating in _________________, arriving in ________________)
______________
Housing: private or university (circle one)
_______________
Meals and other per diem expenses
_______________
Books and educational supplies
_______________
Travel while abroad
_______________
Miscellaneous expenses (please describe – no personal expenses such as souvenirs)
_______________
________________________________
________________________________
________________________________
________________________________
________________________________
Total
_______________
In order to pay for this time abroad, I have the following financial help.
Describe
Amount
Scholarships & Fellowships
Loans & Grants
Personal resources
______________
Family contribution
Other sources
Total
_
Rotary International District 5440 Scholarships
TERMS AND CONDITIONS
I hereby apply for a Rotary International District 5440, Inc. Scholarship.
I certify that I am eligible to apply, understanding that persons in the following categories are ineligible: (a) a
Rotarian or Honorary Rotarian; (b) an employee of a Rotary club or district, of Rotary International, or of another
Rotary-affiliated entity: (c) a spouse, a lineal descendant (child or grandchild by blood or by legal adoption), a
spouse of a lineal descendant, or ancestor (parent or grandparent by blood) of any living person in categories (a)
or (b); and that Rotarians and their relatives as described above remain ineligible for 36 months after resignation
from a rotary club.
I hereby acknowledge that I know I am competing for these scholarships with fellow Study Abroad Students from
the Colorado State University, University of Northern Colorado and the University of Wyoming. All three
universities are located within the boundary of Rotary District 5440.
I hereby acknowledge that I understand the purpose of this scholarship, how this scholarship is made possible, the
program objectives of this scholarship and know the 6 Areas of Study from which I can choose to study. I agree to
assume the role of Ambassador of Goodwill.
And, if I receive a District 5440 Rotary Scholarship, I agree:
1) To learn about Rotary International, The Rotary Foundation, Rotary Districts and Rotary Clubs.
2) To accept the role of a Rotary District 5440 Ambassador of Goodwill which will include but will not be
limited to:
a)
I will contact and establish a relationship with a nearby Rotary club, if one exists.
b) I will present as least 10-15 talks to various Rotary and non-Rotary audiences during my scholarship
period and attend a District 5440 District Conference if invited.
c) I will maintain academic studies with character and distinction.
d) I will submit required reports to District 5440 Foundation and Scholarship Committee describing
my academic progress and Rotary and non-Rotary activities during my program, as well as, a final
report.
e) I will become a member of District 5440 Rotary Foundation Alumnae.
3) To help promote Rotary and District 5440 wherever possible and to permit District 5440 to use my name
and all photographs and written reports generated through any of my activities related to my scholarship.
4)
That I will adhere to all of the requirements, rules and regulations of my University’s Study Abroad
Program and Rotary District 5440.
Rotary International District 5440 Scholarships
5) That I am responsible for gaining admission to my program and/or study institution, obtaining required
visa(s), making appropriate travel arrangements and abide by any other requirements/decisions that may
be necessary.
6) That I am responsible for all costs incurred in completing my pre-departure requirements, including any
application or visa fees, any required exam fees, and appropriate insurance coverage.
7) That I am responsible for all costs associated with my spouse or dependents who may accompany me
during my scholarship period.
8) That once my scholarship has been approved by the District 5440 Scholarship Committee, I cannot change
the type of scholarship awarded to me.
9) That my scholarship will not necessarily enable me to earn a degree, diploma, or certificate.
10) That my scholarship may only be used to fund or help fund: Tuition and Fees, Housing, Airfare, Meals,
Books and Educational Supplies. All other costs are my responsibility.
11) That I will provide Rotary District 5440 with a budget/evidence that I can meet any financial requirements
beyond the scholarship amount at time of application.
12) That my scholarship may be revoked for any of the following reasons: my inability to secure admission to
the program; low level of academic achievement; evidence of misconduct; failure to submit required
reports on time; change in study program without the consent of the University Study of Abroad Program
and Rotary District 5440; withdrawal from the program prior to expiration of the scholarship term; failure
to perform duties. I understand that revocation of a scholarship shall cause all payments to cease and
may make me liable for the return of payments previously received.
13) That Rotary International, The Rotary Foundation, Rotary District 5440 and it’s clubs and individual
Rotarians, The University Study Abroad Program, and the study institution or program are in no way liable
for a scholar’s personal welfare or responsible for enabling a scholar to pursue his or her studies beyond
the scholarship period. The above entities assume no responsibility or obligations whatsoever beyond
providing the amount of the scholarship.
____________________________________
___________________
Signature:
Date
Print Name: