Application 

WEST COLUMBIA ROTARY CLUB 

P.O. Box 943

West Columbia, Tx 77486

J.C. ROGERS SCHOLARSHIP 

I. NOEL SNOW SCHOLARSHIP 

Wayne Pollard Scholarship 

IDENTIFICATION NUMBER _________________ (TO BE FILLED OUT BY COUNSELOR) 

FATHER'S OCCUPATION ___________________________________________________________________________________ EMPLOYER __________________________________________________________________________

MOTHER'S OCCUPATION __________________________________________________________________________________ EMPLOYER __________________________________________________________________________

NUMBER OF DEPENDENT CHILDERN IN HE FAMILY _______________ AGES _______________________________________________________________________________________________________________________

COLLEGE PREFERENCE ____________________________________________________________________________________ COURSE OF STUDY _________________________________________________________________

LIST  ACADEMIC AWARDS AND HONORS

LIST EXTRA CURRICULAR ACTIVITIES INCLUDING HOBBIES AND SPECIAL TALENTS 

LIST ACTIVITIES OF SERVICE TO THE COMMUNITY IN WHICH YOU ARE INVOLVED 

DESCRIBE ANY SPECIAL CIRCUMSTANCE WHICH INDICATES FINANCIAL NEED 

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TO BE COMPLETED BY SCHOOL OFFICIAL

CLASS RANK _________________________________  GPA_________________________________________________ SAT SCORE ___________________________________________________

INDENTIFICATION NUMBER ________________________  (TO BE FILLED OUT BY COUNSELOR)

THE WEST COLUMBIA ROTARY CLUB IS A SERVICE ORGANIZATION THAT PROMOTES SERVICE AND SUPPORT TO THE COMMUNITY.  OUR MOTTO IS 

"SERVICE ABOVE SELF"  PLEASE WRITE AN ESSAY IN RESPONSE TO THE FOLLOWING PROMPT: 

SERVICE TO THE COMMUNITY AND OTHERS IS IMPORANT BECAUSE ........