Scholarship Application

Application deadline: Friday, April 17, 2026.

Student Information
Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Date Residence Began*
MM slash DD slash YYYY
Home Phone*
Parental Information*
Parent Name Parent Occupation
Financial Information
Parent's Combined Adjusted Gross Income, Last Year*
Student's Combined Adjusted Gross Income, Last Year*
Number of Family Members Currently Enrolled in College*
NOTE: IF SELECTED THE APPLICANT MUST SUBMIT IRS FORMS FOR BOTH PARENTS AND THE STUDENT, TO CONFIRM THE ABOVE FINANCIAL DATA.
Other Financial Aid
Please list any other form of financial aid applied for or you will be receiving, I.E. scholarships, grants, loans, etc.

Education Data
High School Attended*
Graduation Date*
MM slash DD slash YYYY
Composite Scores*
ACT Score SAT Score H.S Grade Point Avg.
Higher Learning Institution You Plan To Attend*
Institution Address*
Street Address Address Line 2 City State ZIP Code
Have You Been Accepted to The Institution Above?*
- Yes
- No
Intended Major*
Activities Section
This section is divided into three parts. Please list each activity only once. Please DO NOT abbreviate.
Part A: Work History*
Description of paid employment while attending high school, including summers.
Employer School Year Avg. Hour Worked Per Week Number of Weeks Per School Year
Part B: Academic*
Academic activities sponsored by high school, I.E. Science Language, Math clubs, etc
Activity Name School Year Office Held/Years Held (if any) Hours/Years in Club and Significant Contributions
Part C: Non-Academic*
Organized volunteer, community, or other activities not sponsored by high school, I.E., Scouts, music, church, hospital, etc.
Activity Name School Year Number of Weeks Involved Significant Contributions or Special Recognition

Essay
Please prepare a double-spaced, typewritten essay of approximately 250 words on the following topic: "My Educational and Career Objectives." Place the title with your name and address at the top of the essay, and then attach the essay to this application.
Upload Essay*
Accepted file types: docx, pdf, doc, txt, jpg, png, gif, jpeg, Max. file size: 15 MB.
Release of Information
I hereby authorize the release of information from my high school academic records to members of the Board of Directions of the Destin Rotary Scholarship Fund, Inc. I understand that the information will be used to determine the awarding of scholarship grants.
Acceptance of Release*
- Confirm Release
- Decline Release
Your Full Name as Digital Signature*
Today's Date*
MM slash DD slash YYYY

Employer	School Year	Avg. Hour Worked Per Week	Number of Weeks Per School Year

Activity Name	School Year	Office Held/Years Held (if any)	Hours/Years in Club and Significant Contributions

Activity Name	School Year	Number of Weeks Involved	Significant Contributions or Special Recognition

Parent Name	Parent Occupation