Key Club Scholarship Application

Serving the Children of Richmond

To be considered for this scholarship, ALL OF THE REQUESTED INFORMATION MUST BE RECEIVED BY Monday, May 5, 2025. Before completing your application, have everything requested available. Uploads must be in .pdf format. If you have any questions, please call Jim Ryan at 804-338-3756 or email him at jameseryan@verizon.net.

This form cannot be saved for future use.

Applicant Name (Applicant must be a graduating senior who will be continuing his/her education in the Fall 2025)

First Name

Last Name

Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

High School Attending

High School Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

High School Phone

(###)

###

####

Who is the Key Club Advisor at your high school?

First Name

Last Name

PART 1: PARTICIPATION IN KEY CLUB ACTIVITIES

A. How long have you been in Key Club? (Years/Months)

B. Please name Key Club activities in which you have been a participant or an attendee:

Please name extracurricular activities in which you have been a participant (e.g. school activities and organizations, prizes, honors, offices, etc.):

PART II: ACADEMIC PERFORMANCE

What is your cumulative Grade Point Average (GPA)?

PART III: POST-SECONDARY INSTITUTION ADMISSION

Please name the colleges or post-secondary institutions to which you have applied for admission:

Please name the colleges or post-secdonary institutions which have accepted you for admission:

Have you been offered scholarship assistance that prevents you from accepting the Kiwanis scholarship?

PART IV: ESSAY AND LETTERS OF RECOMMENDATION

Certification

I certify that all information submitted in this application form, and all other information submitted as part of the application process for consideration of this scholarship is true, accurate, and complete to the best of my knowledge and belief.

Parent/Guardian Name and Address, if different

Date

YYYY

Serving the Children of Richmond,
and the World

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Serving the Children of Richmond, and the World

Serving the Children of Richmond,
and the World