This scholarship, awarded without preference as togender, color, creed or religion, is open to all Hicksville residents who are graduating from a high school other than Hicksville High School. Hicksville Kiwanis established this scholarship to recognize special individuals who exemplify the objectives of Kiwanis International. The recipient must be in the top 25% of the class, demonstrate financial need and be attending an institution of higher learning. Preference will be given to students who demonstrate social involvement/community service. This completed application, including one letter of recommendation from community leaders/sponsors and or individuals who can attest to your community service, and one letter from a teacher/counselor who can speak to your scholarship, should be returned in a sealed envelope, to Elizabeth Goldfrank, Assistant Director at Hicksville Public Library by Monday, May 16, 2011.

Please TYPE or PRINT all information.

NAME: ___________________________________________________________________________

             LAST                    FIRST                 MIDDLE INITIAL

ADDRESS:______________________________________________________________________

HOME PHONE: __________________________

FINANCIAL PROFILE: This section is to be completed by the parent or guardian and is based on the information supplied in last year's US Federal Income Tax return.

LAST YEAR'S ADJUSTED GROSS INCOME:_________________

Since our scholarship program is designed for students with demonstrated financial need please explain any unusual financial circumstances of which the committee should be aware.

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I certify that the above financial information is complete and accurate to best of my knowledge.

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PRINT NAME OF PARENT OR GUARDIAN                SIGNATURE OF PARENT OR GUARDIAN

ACADEMIC PROFILE:

HIGH SCHOOL ATTENDING: ________________________________

4-YEAR HIGH SCHOOL AVERAGE: _________________         CLASS RANK: ______________

SAT SCORES            MATH: _____________                 VERBAL: ____________

SCHOOL OR COLLEGE YOU PLAN TO ATTEND: ____________________________________

NAME OF GUIDANCE COUNSELOR: ______________________________________________

THE ABOVE INFORMATION MUST BE VERIFIED BY THE GUIDANCE OFFICE

GOALS STATEMENT: Please discuss your future goals and how your post-secondary education will help you realize these goals.

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