2023 Online Arell College Scholarship Application (Dependent Student Status)

Two and Four Year College Applicants

Eligibility Criteria

Applicant must meet one of the following criteria:

• Be enrolled or be a recent graduate of a high school in Concord or Penacook. NH This includes Concord High School, Merrimack Valley High School, Bishop Brady High School, Concord Christian Academy, Parker Academy, St. Paul’s School, or Trinity Christian School.
• OR, Applicant must be a current resident of Concord or Penacook, NH.
• AND
• Applicant must be entering or attending a two or four year college.
• Applicant must demonstrate financial need.
• Applicant may be a full-time or part-time student.
• Applicant may be a home-schooled student.
• Applicant may be a first-year or returning student.
• Applicant may re-apply for additional scholarships in subsequent years.
• Immediate family members of Rotary Club of Concord are not eligible.

Instructions for Two and Four Year College Applicants

• Applications must be fully completed and include all required materials.
• The Application period is from March 1 to May 2, 2022.
• Applications must be received no later than May 2, 2022.
• All questions must be answered in the fields provided in the form below.
• No Supplemental pages or materials will be accepted.

A completed Application includes:

• The Rotary College Scholarship Application completed and submitted below.
• Your Official High School or College Transcript.
• Score Reports of your SAT (optional), ACT (optional), and/or TOEFL, if applicable.
• A Letter of Recommendation from a high school or college teacher or counselor.
• A readable copy of your FAFSA Student Aid Report page which includes your EFC (Expected Family Contribution) amount.

Please complete the online form below. There is an option at the bottom of the form to save the application and return to complete it at a later time. When you have determined that your application is thoroughly complete, please click the Submit button.

• • BASIC INFORMATION

    Full legal name *

    Date of birth *

    Gender *

    • Female
    • Male
    • Other

    Country of citizenship *

    Email *

    Cell phone *

    Home phone *

    Mailing address *

    Address Line 1

    Address Line 2

    City

    AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

    Zip Code

    High School or College you are attending (Name, City, State) *

    High School graduation date (month & year) *

    College you will attend (Name, City, State) *

    Start date *

    College year you will attend in 2022/2023 *

    • Fr.
    • Soph.
    • Jr.
    • Sr.

    Graduation date *

    
    

    DOCUMENT CHECKLIST/UPLOADS

    A high school transcript or college transcript (Only PDF and DOCX file types allowed) *

    Click or drag a file to this area to upload.

    A letter of recommendation from a teacher, professor, counselor, or employer (Only PDF and DOCX file types allowed) *

    Click or drag a file to this area to upload.

    A readable copy of your FAFSA Student Aid Report page which includes your EFC (Expected Family Contribution) amount. *

    Click or drag a file to this area to upload.

    The following file types are allowed: pdf; docx; jpg; png; bmp.

    
    

    PERSONAL STATEMENT

    Describe your career goals and your educational plans to get there: *

    Describe any relevant personal and/or family circumstances relevant to this request for financial assistance: *

    
    

    ACTIVITIES AND WORK

    List any school, club, or community experiences to help us better understand you and your application for financial assistance:

    Activity 1

    Describe your participation

    Participation dates

    Activity 2

    Describe your participation

    Participation dates

    Activity 3

    Describe your participation

    Participation dates

    List any work or work-based (job shadow, internship) experiences to help us better understand you and your application for financial assistance:

    Employer 1

    Position held

    Participation dates

    Employer 2

    Position held

    Participation dates

    Employer 3

    Position held

    Participation dates

    
    

    STUDENT STATUS: Dependent

    Parent/Guardian 1 name

    Parent/Guardian 1 occupation

    Single, married, separated, divorced, or widowed

    Parent/Guardian 2 name (if applicable)

    Parent/Guardian 2 occupation

    Single, married, separated, divorced, or widowed

    Total number of family members *

    Total number of family members attending attending college (including you) in 2022/2023 *

    
    

    FINANCIALS

    Please complete the following section in cooperation with your parent/guardian(s) based on their most recent taxable year.

    APPROXIMATE INCOME

    Income earned by parents/guardians - from IRS Form 1040 line 11 *

    Income earned by you - from IRS Form 1040 line 11 *

    Other income (please enter dollar amount and explain source of other income) *

    TOTAL INCOME *

    
    

    APPROXIMATE ANNUAL EDUCATION-RELATED COSTS

    Tuition and fees *

    Room and board (if staying on campus) *

    Commuter miles at approximate IRS rate (Daily round trip miles x $.56 per mile x number of days) if off-campus *

    Book costs *

    Technology, lab, health insurance costs (enter costs and explain) *

    Enter any other costs and explain *

    TOTAL COSTS *

    
    

    APPROXIMATE EDUCATIONAL FUNDING PLAN

    Amount you and/or your family can pay *

    College work-study

    Federal grants

    College grants

    Loans

    Other amount (including VA Benefits) - please explain amount

    TOTAL FUNDING RESOURCES *

    TOTAL UNFUNDED COSTS (TOTAL COSTS minus TOTAL FUNDING RESOURCES) *

    
    

    FAFSA and EFC *

    • I have submitted my FAFSA
    • I have attached my Student Aid Report and EHC

    EFC Amount *

    
    

    How did you hear about the Concord Rotary Club's Scholarship Program? *

    
    

    SIGNATURE FIELDS BELOW: Please use your mouse (if on a desktop/laptop) or your finger (if on a phone or tablet) to write your name in the field below. Keyboard entries are not accepted.

    Applicant signature *

    Clear Signature

    Date *

    Parent, Guardian or Spouse signature if under 18

    Clear Signature

    Date

    After submitting your Workforce application, you will receive an email confirmation that displays all your application entries. Please save and/or print that email for your records.

    SubmitSave and Resume Application Later

    Saving your progress now will store a copy of your entry on this server. For security reasons, file uploads will have to be re-entered when you resume.

    Please click the Continue button to view and copy a link to use when you resume filling out your application or to receive the resume link via email.

    Continue Go Back

    Your entries to the Arell College Scholarship Application have been saved and a unique link has been created which you can access to resume this form.

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    Email *

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