For a Kiwanis Scholarship*
To be awarded by
The Kiwanis Club of
Greater Hot Springs Village
1. Legal Name 2. Social Security Number - -
Last First Middle
3. Permanent Address
4. Telephone Number ( ) 5. E-Mail Address
6. Do you plan to enroll full time in at least 12 credit hours? ( ) Yes ( ) No
7. Semester you are applying for? ( ) Fall ( ) Spring ( ) Summer
8. At the time of this application are you: ( ) A high school senior or graduate? ( ) A current college student?
( ) Planning to attend college after a period of not attending school?
9. Institution of Choice: Accepted Yet? ( ) Yes ( ) No
10. Proposed College Major:
11. Citizenship Status: ( ) US Citizen ( ) Other, define status:
12. Financial Status: Please indicate your/family** annual income from the following brackets:
(a) 0 -$15,000 (b) $15,000 - $25,000 (c) $25,000 - $40,000 (d) $40,000 - $60,000 (e) greater than $60,000
13. List all other financial assistance you expect to receive.
(List each source of assistance by name of Grantor and amount granted. Use additional space if needed.)
14. Please check one: ( ) Male ( ) Female 15. Birth Date / /
16. Are you a Kiwanian or the son or daughter of a Kiwanian? ( ) Yes ( ) No
17. High school currently attending or graduated from:
18. High school graduation date: / /
19. If you did not graduate from high school, do you have a GED? ( ) Yes ( ) No
20. College or Institution currently attending (if any)
You must provide academic verification of your cumulative grade-point average on a 4.0 scale and/or ACT scores, in order to be considered
for a scholarship from the Kiwanis club. You may provide this verification by:
* Attaching y our high school transcript with grades and ACT scores to this application, OR
* Having a school official complete this section, OR
* Attaching a copy of your official GED score report, OR
* Attaching your college transcript of grades and courses taken.
Cumulative GPA: Final GPA: Composite ACT Score: Class Ranking out of
Name of School Signature of High School Counselor or College Official
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Kiwanis Scholarship Application page 2
1) Attach a personal essay describing your career objectives, include an explanation of your financial need.
2) Attach a letter of recommendation from a past instructor, counselor, principal, or employer.
3) Attach a copy of all college transcripts. You may also request a copy from the Registrar’s Office at your former college(s) and
attach them to this application.
4) Attach a listing of all extracurricular activities and honors during high school and college (if applicable).
I certify the information on this application is complete and correct and that I have accounted for all prior academic work.
I also agree to adhere to the conditions of the scholarship contract, should I be awarded one. This includes maintaining
enrollment in 12 or more credit hours per semester (or the number required by the scholarship, if less than full time) and
maintaining the required cumulative grade point average. By signing this statement, I also hereby authorize the release of
all my high school and/or college transcripts and other pertinent records to the Kiwanis Club of Greater Hot Springs
Applicant Signature Date
Please return this application before April 15, 2020 to:
Chairman of the Scholarship Committee
The Kiwanis Club of Greater Hot Springs Village
6 Berlanga Circle
Hot Springs Village, AR 71909
* This application is used for considering applicants for scholarships directly awarded by the Kiwanis Club of Greater Hot Springs
Village independently of the Kiwanis International Organization. In general, any s uch scholarship is awarded for a single school
year, but in cases where the Kiwanis Scholarship Committee deems appropriate, awards may be made for following years where
the students has maintained a satisfactory college record. The scholarships to be awarded are intended for seniors of Fountain
Lake High School and students at National Park Community College. Most other students are not eligible for these scholarships.
** Family income is meant to include earnings or other sources of income by the student and parents. If the student is 21 or older
and living independently, the students income is applicable.
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