WOODBRIDGE ROTARY SCHOLARSHIP FOUNDATION, INC. P. O. Box 201 • Woodbridge, New Jersey 07095 Rotarywpa.org

Student Name

Applicant Information

Full Name:	Date:	Click or tap to enter a date.
Last	First	M.I.

APPLICATION INSTRUCTIONS

Applicants must read and follow these instructions carefully. The following criteria must be satisfied in order to be considered for a scholarship to be awarded by the Woodbridge Rotary Scholarship Foundation, Inc.:

1. Applicants must be full-time residents of Woodbridge Township, New Jersey, since January 1, 2022.

Applicants must possess a high school diploma or the equivalent at the time the scholarship is awarded. Applicants do not have to be graduates of the Woodbridge Township high schools.

Applicants must be pursuing a post-high school full-time course of study at an accredited college, university, trade school, or other educational institution.

4. Applicants must submit, or arrange for the delivery of, the following information by April 25, 2023:

a. The attached application completed in full, including appropriate signatures.

A copy (single sided only) of the applicant's and parents' most recent Federal income tax returns, including all applicable Schedules.

c. A copy of the applicant's most recent school transcript.

Applicant must arrange for a character reference from a school official (teacher, guidance counselor, principal, etc.). The school official should send the reference directly to the Scholarship Foundation and must state that the contents of the reference were not disclosed to the applicant. References which do not so indicate will be deemed to have been seen by the applicant.

On a separate sheet (typed, single-sided), please explain your goals and why you feel you should be awarded a scholarship.

All material submitted in connection with an application for a scholarship becomes the property of the Woodbridge Rotary Scholarship Foundation, Inc. and will not be returned. All applications and supporting information will be kept confidential. All scholarships will be awarded without regard to an applicant’s race, creed, religion, or color. All decisions regarding scholarships are in the sole discretion of the Woodbridge Rotary Scholarship Foundation, Inc. and are final.

THE FOUNDATION WILL NOT CONSIDER ANY APPLICATION THAT DOES NOT CONTAIN ALL THE INFORMATION REQUIRED.

Certification: All of the information on this form and the Supplemental information, if completed, is true and complete to the best of my knowledge. I understand that if any of the information contained in this application is false, I may be disqualified from consideration for a Scholarship. If I am awarded a Scholarship and it subsequently is discovered that any information contained herein is false, fraudulent, or willfully erroneous, I may be required to repay all monies received from the Woodbridge Rotary Scholarship Foundation, Inc.

Everyone giving information on this form must sign below.

Student Signature:	Parent/ Guardian:

Student Identification Information

Name:
Last	First	M.I.

Permanent Mailing Address:
Street Address	Apartment/Unit #

City	State	ZIP Code

Phone:	Email:
Date of Birth:	School Presently Attending:

Student Status

High School Senior Applicants:

Current Class Rank:	SAT Scores:	Verbal:	Math:	Writing:

College or University Applicants:

Cumulative GPA:	Year in School Completing:	1 ☐	2 ☐	3 ☐	4 ☐	4+ ☐	Graduate ☐

Are you a resident of Woodbridge?	☐	☐	If so, date you began living in Woodbridge Township:	Click or tap to enter a date.
YES	NO

Have you previously had a scholarship from the Woodbridge Rotary Scholarship Foundation, Inc.?

YES ☐	NO ☐	If yes, when?	Please list the amount of your award(s):

Please list all scholarships and grants that you have received, have been awarded or anticipate receiving for the upcoming school year. Indicate sources and amounts of awards already approved and the source of awards you anticipate receiving. If you have not applied for any and do not anticipate applying for any, please so indicate.

For those applicants currently attending a college or university, did you receive any of the following during previous school years: Pell Grants, any school grants or scholarships, and/or private foundation grants? If so, sate the amount and source. If you did not, please write “None.”

Education

High School:	Address:

From:	To:	Did you graduate?	YES	NO	Diploma:

College:	Address:

From:	To:	Did you graduate?	YES	NO	Degree:

Other:	Address:

If you know at this time, please provide the name of the school you will be attending in the fall of 2023 and the itemized costs for tuition and room and board for the year.

SCHOOL	ANNUAL TUITION	ANNUAL ROOM AND BOARD

If you do not know at this time which school you will be attending in the fall of 2023, please list all schools you have applied to attend. Please indicate which schools to which you have been accepted. Additionally, please list itemized costs for room and board for each school.

SCHOOL	CHECK IF ACCEPTED	ANNUAL TUITION	ANNUAL ROOM AND BOARD

Provide your enrollment status during the 2023-24 school year (check only one).

Full-Time	At least half-time but less than full-time	Less than half-time

Household Information

If you receive more than one-half of your support from your parents, please indicate the following:

FAMILY MEMBER LISTING

Fill in information for up to seven other family members in your household other than yourself. If there are more than seven, list first those who will be in college at least half-time. List those over seven in “Explanations/Special Circumstances.”

Full name of family member	Age	Relationship (Use Code Below)	Will attend college at least half-time in 2023-24 school year?	Name of school or college this family member will attend in 2023-24 school year	Occupation/ Employer of this family member	If attending same school in 2023-24, list amount of:
Yes	No	2023-24 Scholarships/ Grants	2023-24 Parents’ Contribution

Relationship Code: 1= Student’s Parent	3=Student’s brother/sister 5=Student’s Son/Daughter 7=Other (Explain in

2= Stepparent 4=Student’s spouse 6=Student’s grandparent “Explanations:	Special Circumstances”)

Income, Earnings and Benefits

Student’s Present Occupational Employer:

Company:
Address:

Will student continue to work for this employer during the 2023-24 school year?	YES	NO

Attach a copy of parents’ and applicants’ 2022 1040 US Tax Returns, including all applicable schedule. In addition, fill out the information below.

Asset Information:

Asset Type	Parents	Student
2022 Value	2022 Value
Cash, savings and checking accounts
Marketable securines.,j.e., stocks, bonds & mutual funds
IRA, 401(k), 403(b), and other retirement plans
529 college savings plans
Home (Renters write in “0”)
Real estate investments
Business interests

Other Information

Parents’ monthly home mortgage or rent:	$

Have you or your parents made any gifts or transfers to family members or trusts in excess of $1,000.00 during the past 24 months? If “Yes,” explain in EXPLANATION OF SPECIAL CIRCUMSTANCES” below.	YES	NO

Explanations/Special Circumstances

Use this space to explain any unusual expenses, educational and other debts, or special circumstances.

Extracurricular Activities and After School Work Experience

List extracurricular activities and/or work experience:

Have you ever been convicted of a crime?	YES	NO

If so, please provide details.

On a separate sheet (typed, single-sided) please explain your goals and why you feel you should be awarded a scholarship.

WOODBRIDGE ROTARY SCHOLARSHIP FOUNDATION, INC.

P. O. Box 201 • Woodbridge, New Jersey 07095

Checklist of Items

Completed application
Applicant’s and Parent’s Federal Income Tax Return, including all applicable Schedules
School transcript
Written statement explaining goals and reason scholarship should be awarded to applicant
Character reference, supplied by individual proving reference

All of the above items are required to submit a complete application.

Only complete applications will be eligible for consideration.