KIWANIS CLUB OF ELLICOTT CITY
Application for Scholarship Renewal
To the Kiwanis Club of Ellicott City.
I hereby make application for renewal of the Kiwanis Club of Ellicott City Scholarship for the college year starting August/September, 20___. In addition to this application, please include a copy of completed courses and grades for the previous school year.
(Please print in ink or type)
Name: _______________________________________________________________________________
(Last) (First) (Middle)
Home Address:________________________________________________________________________
(Street)
____________________________________________________ _______________
(City & Zip) (Phone)
E-mail address: ___________________________________________________
Social Security Number: ________ - ______ - ________
University/College presently attending: ______________________________________________
Estimate of school expenses for the next year:
Tuition: __________ Books: __________ Room/Board: __________ Total: __________
_______________________________________________________________ ____________
Applicant's Signature Date
_______________________________________________________________ ____________
Parent's/Guardian's Signature Date
Please return this application with a copy of your college transcript to:
Kiwanis Club of Ellicott City
c/o Robert S. Scarburgh
8546 Marybeth Way
Ellicott City, Maryland 21043-6659
Phone (410) 465-2421 E-mail: rscarburgh@aol.com
Submit these materials no later than June 15.
Rev. 2/97