KEY CLUB

20 0 8 S ch o l ar s hi p I n f o r m a t i on
 Key Club International 2008 Scholarship Program
Students will apply for the International Scholarships through the district scholarship application
process. If the district does not have its own application form, the enclosed 2-page application
form may be used. Districts will then send to Key Club International, one finalist for each Key
Club International Scholarship that we offer. A committee will determine the winners of the
scholarships here at the International level.

All scholarships are provided as cash awards in the form of a check issued to the college or
university and the student. This check is sent directly to the college or university for deposit into
the student’s account and most likely will require the student to endorse the check. Checks are
disbursed in August from the Kiwanis International Foundation. A copy of the letter and check is
sent to the recipient’s home address.
Recipients are announced at the 2008 Key Club International Convention and then are posted on
the Key Club International Website. All questions regarding this program should be directed to
Key Club International, Youth Funds & Scholarship Specialist, 800/549-2647, ext. 1244.
Key Club International Scholarships Available Are:
• Key Club International Youth Opportunities Fund Scholarship: two US$4,000 four-year
scholarships awarded in US$1,000 increments. Funded by Key Club International reserve
investment earnings.
• Himmel Scholarship: one US$500 scholarship. Funded by family and friends of Harry S.
Himmel, deceased President Emeritus of the Kiwanis International Foundation.
• David Hancock Memorial Scholarship: one US$4,000 scholarship awarded in US$1,000
annual increments. Funded by his family, in memory of deceased Kiwanian and Key Club
supporter David Hancock. Applicants for this scholarship can attach no more than 10 pages of
supporting documentation (including photographs, clippings, etc.) – the supporting materials
must be limited to 8-1/2 by 11-inch pages; and an essay. The application is included at the
back of this packet and must be submitted separately to the address provided.
• Party for a Purpose Scholarship: two US$4,000 scholarships awarded in US$1,000 annual
increments. Funded by Kiwanians and guests attending a reception at the Kiwanis
International Foundation Reception at the Kiwanis International Convention in San Antonio.
• Robert Thal Scholarship: one US$1,000 scholarship. Funded by contributions from friends
and family of deceased past Florida District Governor Robert Thal.
• Stephen Sapaugh Memorial Scholarship: one US$4,000 scholarship awarded in US$1,000
annual increments. Funded by an endowment fund established in memory of deceased Key
Club member Stephen Sapaugh.
• TruGreen Scholarship: one US$500 scholarship funded by TruGreen. It will go to an
outstanding Key Club member who has been involved in school or community beautification
projects. Students applying for this scholarship must write a 200-word essay describing a
beautification project they participated in. This essay must be signed by the Key Club Advisor.
• Cunat International Scholarship: one US$2,500 scholarship provided by Kiwanis
International Past President Brian and Miki Cunat. Based upon leadership in his or her line of
study, regardless of grade point average or financial need. This application is included at the
back of this packet and must be submitted separately to the address provided.
To apply for these scholarships, you must submit either your District Scholarship Application with the
KCI cover sheet, or the KCI Scholarship Application through your district by their deadline!
 Key Club International Scholarship
To Be Attached To District Scholarship Application
Submit With District Scholarship Application

Name Key Club Member Number

First middle last

Permanent Address
Street Address

City State/Province Postal Code Nation

Home Phone with Area Code / E-mail Address

Parents’ Names

College Key Club District

Key Club International Scholarships I Am Applying For (check all of the scholarships for which you
want to be considered):
Key Club International Youth Opportunities Fund Scholarship
Himmel Scholarship
Party for a Purpose Scholarship
Robert Thal Scholarship
Stephen Sapaugh Memorial Scholarship
TruGreen Scholarship (must attach 200-word essay of campus or community
beautification project participated in; signed by Key Club Advisor)

UNIVERSITY INFORMATION
I have not finalized my decision as to which school I will be attending in the fall.
I will be attending the following school
(The scholarship check will be sent directly to the school’s Financial Aid or Scholarship Office.
Please secure the address of this office.
University Name

Office check to be mailed

Address
Campus address

City State/Province Zip/Postal Code Nation

HOMETOWN NEWSPAPER ADDRESS

Name of Hometown Newspaper

Address
Campus address

City State/Province Zip/Postal Code Nation

Signature
I verify that this information is accurate,

Applicant Printed Name

Date
 Scholarships Available to Key Club Members by Other Organizations:

• Arizona State University Leadership Scholarship: LSP recognizes outstanding high school graduating
seniors who have achieved excellence in leadership. Established in 1977 to aid in the growth of student
leaders on campus, this program has a long-standing history at ASU. More than a scholarship program,
students become part of a family. Students in the program will participate in the following: CED 194, a
leadership development course designed specifically for this program; one-on-one mentoring by an ASU
staff member; monthly meetings with all current ASU LSP students; social activities, such as a weekend
retreat; community service; and networking with LSP alumni. Students may use the scholarship for
tuition and fees, housing, and other educational expenses. The nonresident award is $17,000 annual
scholarship, renewable for three additional years; four out-of-state seniors will be selected who must
have been active members of Key Club with a 3.0 unweighted GPA. To apply, you must complete the
application and submit it with a copy of your high school transcripts with ACT/SAT scores, a list of
high school activities (include brief description of organization, dates of participation & leadership
positions held), list of community service and volunteer projects (include total hours and dates of
participation), list of honors, awards and special leadership programs attended (i.e. classes, workshops,
conferences); and answer two of the following three questions in essay format (a maximum of two pages
per answer): 1) If you could ask three questions to any leader (living of deceased), who would you ask,
what would the questions be, and why? 2) In your opinion, who is more effective and why: one who
leads by outward action or one who leads by silent example? Which type of leader are you? 3) If you
were asked to give a speech to your peers concerning your “passion” in life, what would your speech
sound like? Two letters of recommendation (if you are a nonresident, one must be from Key Club
sponsor). Submit materials by December 1, 2007 to: Leadership Scholarship Program, Undergraduate
Admissions, Attention: Vicki Samara, Arizona State University, PO Box 870112, Tempe, AZ 85287-
0112. For more information, please call 480-965-3040 or visit us online: www.asu.edu/admissions/lsp.

• DePauw University Bonner/Wright Scholarship: two scholarships valued at more than $13,000. Each
recipient will receive an annually renewable $10,000 John Ellis Wright Award in addition to a Bonner
Scholarship valued at up to $3,600. The two Key Club members will be selected for the DePauw
University Bonner/Wright Scholarships on the basis of academic achievement, commitment to
community service, and leadership. Recipients are expected to maintain a good academic standing and
become actively involved in community service by joining the Circle K club on the DePauw University
campus. Students receive a stipend during both the school year and summer to support them in their
community service. For information about this scholarship program, contact: Sarah Ryan, Director, or
Jean Everage, Assistant Director, the Bonner Scholars Office, DePauw University, 500 E. Seminary
Street, Greencastle, IN 46135; telephone 765/658-4620; e-mail bonner@depauw.edu. Application
deadline is February 1, 2008. The application is also available via Web site at
http://www.depauw.edu/admission/applying/forms/bonner/_app.asp

• Wittenberg University Key Club International Scholarship: In addition to merit based scholarship
programs, Wittenberg recognizes the unique experiences gained through participation with Key Club
International. Applications who have been involved with Key Club International will be awarded a Key
Club International Special Recognition Award of $1,000 in addition to any merit scholarship they
receive. Selection is based upon acceptance to Wittenberg University, academic achievement,
commitment to community service, involvement in Key Club, and extracurricular activities. The
Wittenberg University Key Club International Scholarship was created in 2002 to recognize Key Club
members’ commitment to community service and leadership. For more information about this
scholarship, please contact Brad Pochard, Assistant Director of Admission, Key Club International
Scholarship, Wittenberg University, PO Box 720, Springfield, OH 45501, 877/206-0332, or
mpochard@Wittenberg.edu. The application for free admission is available online at
www.wittenberg.edu. There is no separate application required for this scholarship. Application
deadline is February 1, 2008.
• Lindenwood University Key Club International Scholarship: unlimited number of awards given in
the amount of US$5,000 (and renewable annually for four years, or up to completion of undergraduate
degree). Selection is based upon acceptance to Lindenwood University, academic achievement,
commitment to community service, involvement in Key Club, and extracurricular activities. Students
must meet the minimum requirement for merit based scholarship assistance (20 ACT and 2.5 high
school or 2.0 transfer college grade point average). Recipients are expected to maintain a good academic
standing and become actively involved in community service by joining the Circle K club on the
Lindenwood University campus. For more information about this scholarship program, please contact
Joanna Finch, Circle K Faculty Advisor, Key Club International Scholarship, Lindenwood University,
209 S. Kingshighway, St. Charles, MO 63301, 636/949-4931, or jfinch@lindenwood.edu. Application
deadline is February 1, 2008. http://www.lindenwood.edu.

• Kappa Alpha Order’s “joinKA.com Scholarship”: two scholarships for Key Club members valued at
$250 each. The two recipients will be selected for the scholarship based on goals similar to Kappa
Alpha Order: scholarship, community service, leadership, and personal development. For information
about this scholarship program, contact Jesse Lyons, Director of Chapter Development, PO Box 1865,
Lexington, VA 24450; telephone 540/463-1865; e-mail jlyons@ka-order.org. Application deadline is
May 1, 2008. The only step to apply is to complete the application included at the back of this
packet, and submit it separately to the address provided.

Kiwanis International Foundation/Key Club District Matching Scholarships

Offered to Participating Districts

Application Deadline Determined by Each District

The Kiwanis International Foundation and Key Club International have designed a scholarship program to
recognize Key Club members who have excelled in leadership and have provided service to others. Financial
need is not a factor in this award. Each winner will receive a one-time US$1,000 award (unless a district
changes the award amount). Districts are eligible to receive up to ten matching scholarships based on the
amount of Kiwanis clubs participating in the Annual Club Gift Campaign with the Kiwanis International
Foundation.

Interested students need to contact their district administrator (or representative, listed below) to determine
the district’s participation in the 2008 program. Applications for this scholarship are mailed directly to
the district administrator, unless he or she instructs otherwise. Each district determines its own deadline.

Key Club International Board members and Key Club district governors are NOT ELIGIBLE for the
District Matching Scholarship program. Each district’s Key Club board is to determine the procedure to
select the district scholarship winner(s). The district administrator is to forward the winning recipient form
and matching funds to the Kiwanis International Foundation by May 21, 2008.

The Kiwanis International Foundation/Key Club District Matching Scholarship recipients will be notified
by the Kiwanis International Foundation, announced at the 2008 Key Club International Convention, and
will be posted to the Key Club International Website. All scholarships are provided as cash awards in the
form of a check issued to the college or university and the student. This check is sent directly to the college
or university for deposit into the student’s account and most likely requires the student to endorse the
check also. Checks are disbursed in August.
Who Is Qualified for the Kiwanis International Foundation/District Matching Scholarship Program
(these are the same qualifications for the Key Club International Scholarships)?
A Key Club Member who:
has been an active Key Club member for two years in good standing.
has paid dues and appears on the roster on file at Key Club International.
is a graduating high school senior
is a college-, university-, technical-, or vocational school-bound student.
has a grade–point average of at least a “B” average or the equivalent of a 3.0 on a 4.0 scale.
has attached an official high school transcript with an explanation of the grading system utilized.
submits the application to the Key Club district administrator by the deadline established by the
district. For further information, contact the administrator.

2007-2008 District Administrators or Contacts

ALABAMA – Bob Bottsford, 6326 Rock Mountain Lake Road, McCalla, AL 35111; 205/424-8331 or
426-2911, or cell 205/541-3293; fax 205/425-8754; e-mail rbottsford@alabamakeyclub.org
Deadline for Application: March 1, 2008

CALIFORNIA-NEVADA-HAWAII – Marek LeBlanc, 29314 Birdy Ct., Nuevo, CA 92567-9493; 951 928-
1244; cnhkeyclubda@verizon.net; send applications to: Bruce Hennings, CNH District Office, 550 Fesler
St, Suite G-3 El Cajon, CA 92020; 877/562-7055; 510/562-0688 fax; e-mail bruce@cnhkiwanis.org
Deadline for Application: February 28, 2008

CALIFORNIA-NEVADA-HAWAII KIWIN’S – Larry Lewis, 1488 Mariposa Way, Fairfield, CA 94533-

9755; 501 620-6641; linkupll@aol.com; send applications to: Bruce Hennings, CNH District Office, 550
Fesler St, Suite G-3 El Cajon, CA 92020; 877/562-7055; 510/562-0688 fax; e-mail bruce@cnhkiwanis.org
Deadline for Application: February 28, 2008

CAPITAL – Joe Stankus, 1229 Bellevue Avenue, Richmond, VA 23227; 804/564-5668; e-mail
Kiwanis@cavtel.com
Deadline for Application: March 22, 2008

CAROLINAS -- J. Scott Johnson, 2008 Pinecrest Drive, Greensville, NC 27858; home 252/355-0644, cell
704/968-1051; e-mail JSJKEY@gmail.com
Deadline for Application: March 1, 2008

EASTERN CANADA –Ken Hanson, 8 Ambleside Ave., Toronto, ON M8Z 2H6 Canada; 416/252-6250;
kenhanson@rogers.com
Deadline for Application: March 1, 2008

FLORIDA – Carmen Calzon, 1825 Ponce de Leon Blvd, #249, Coral Gables, FL 33134; 305/262-5466;
carmencalzon@aol.com
Deadline for Application: March 1, 2008

GEORGIA – Mike "Coach" Goss, 210 N. Letitia Ave., Douglas, GA 31533; 912/384-5158; e-mail
chshammerhead@hotmail.com
Deadline for Application: February 24, 2008

ILLINOIS-EASTERN IOWA – Bob Hall, 28 Candy Lane, Murphysboro, IL 62966-2953; 618/687-2205; e-

mail bhall@intrnet.net
Deadline for Application: January 31, 2008
INDIANA – Dave Wohler, 14714 Wheatfield Lane, Carmel, IN 46302-5014; work 317/875-8755 x 163;
e-mail dwohler@kiwanis.org
Deadline for Application: On or before March 1, 2008

JAMAICA – Navara Dennis, Coleraine Street, Oracabessa PO, St. Mary, Jamaica W.I.; 876/975-3371;
iriesnuff@hotmail.com
Deadline for Application: March 1, 2008

KANSAS – Patricia Wiechman, 1101 W. 10th, Topeka, KS 66604-1105; work 785/223-8862; e-mail
tallgrass2@cox.net
Deadline for Application: February 1, 2008

KENTUCKY-TENNESSEE – Steve Phillips, PO Box 188, Flintstone, GA 30725; home 706/820-2564,

cell 423/309-0765; e-mail sphillips5@aol.com
Deadline for Application: By mail: must be received by March 10, 2008, or turn in at District
Convention March 14, 2008

LOUISIANA-MISSISSIPPI-WEST TENNESSEE –Scott Dupont, 901 Arms Street, Thibodaux, LA

70301; 985/447-6433; sld_3@charter.net; or LaMissTenn Kiwanis District Office (5319-B Didesse Drive)
PO Box 14026, Baton Rouge, LA 70898-4026; business 225/766-9323; e-mail Charlie@lamisstenn.org
Deadline for Application: January 31, 2008

MICHIGAN Greg Smith, 4260 Sandy Creek, Shelby Township, MI 48316; 586/803-1759; e-mail
smith5825@wowway.com
Deadline for Application: March 7, 2008

MINNESOTA-DAKOTAS – Mary Beth Townsend, 7508 Jasmine Avenue South, Cottage Grove, MN
55016; home 651/459-8977; e-mail mary.b.townsend@comcast.net
Deadline for Application: FEBRUARY 16, 2008

MISSOURI-ARKANSAS – Jim Zuroweste, 120 Monroe, Troy, MO 63379; home 636/462-7757 e-mail
jimzur@centurytel.net
Deadline for Application: February 15, 2008

MONTANA – Ed Leland, 2221 Rosewyn, Billings, MT 59102-2147; home 406/652-5625; e-mail

eleland@wtp.net
Deadline for Application: March 11, 2008

NEBRASKA-IOWA – TJ Tjaden, Box 101, Webster City, IA 50595-0101; home in evening 515/832-3192;
e-mail tjcoach@ncn.net
Deadline for Application: must be received in time to be judged on first day of District Convention
which is March 23, 2008

NEW ENGLAND – George Whitney, PO Box 467, Hardwick, VT 05843-0467; home 802/472-6240; e-
mail GRW-KC@vtlink.net
Deadline for Application: March 1, 2008

NEW JERSEY – Barrie Werfel, 36 Williamsburg Dr., Roseland, NJ 07068-1215; home 973/228-2743, cell
973/985-4096; e-mail njdawerfel@aol.com
Deadline for Application: March 1, 2008
NEW YORK – Andy Lowenberg, 92 Budenos Dr., Sayville, NY 11782-2228; home 631/567-4283; e-mail
NYKCA@optonline.net
Deadline for Application: March 1, 2008

OHIO – Jeff Eble, 117 W. Homestead St., Medina, OH 44256; eble_jeff@mail.dublin.k12.oh.us

Deadline for Application: March 1, 2008

PACIFIC NORTHWEST – Doug Baker, PO Box 1119, Milton, WA 98354; 253/891-4015; e-mail
ltg2004@aol.com
Deadline for Application: February 1, 2008

PENNSYLVANIA – Applications go to: Robert Bagans, District Administrator, 320 Nicholas Place,
Sewickley PA 15143-1032; 412-741-5455; rbagans@comcast.net
Deadline for Application: February 8, 2008

ROCKY MOUNTAIN – David Harris, 1641 S. Parfet Court, Lakewood, CO 80232-6130; 303/989-7994;
e-mail RMDKCAd@aol.com
Deadline for Application: Applications for the RMD District Matching Scholarships must be received by
the District Administrator by 7 p.m., April 4, 2008. They may be sent to his house or hand delivered at
the District Convention. Please contact him for district criteria and guidelines.

SOUTHWEST – Vickie Biehn, 3172 Horseshoe Canyon. Lane, Lake Havasu City, AZ 86406; phone
928/453-5051; e-mail keyclubpal@yahoo.com
Deadline for Application: Received by March 30 if mailed, or submit at the District Convention on
April 17, 2008.

TEXAS-OKLAHOMA – Dennis Mitchell, mail applications to Chuck O’Toole at the T-O District Office,
624 Six Flags Dr. Ste. 265, Arlington, TX 76011-6342; phone 817/640-7711; e-mail chuck@itexas.com
Deadline for Application: March 1, 2008

UTAH-IDAHO – Peter J. Van Hook, 4710 Fortuna Way, Salt Lake City, UT 84124-5620; 801/232-5046;
e-mail pjvanhook@msn.com
Deadline for Application: April 8, 2008 The district has its own application form and instructions that
are mailed in January to each faculty advisor with the district convention packet

WEST VIRGINIA – Richard Yurko, PO Box 2190, Clarksburg, WV 26302-2190; 304-624-8103; e-mail
Richard.yurko@steptoe-johnson.com. West Virginis has its own application that is sent out along with
District Convention materials.
Deadline for Application: March 12, 2008

WISCONSIN-UPPER MICHIGAN – Kathy Vorpahl, 531-A Park Street, Combined Locks, WI 54113;
cell 920/475-0500; e-mail wium.admin@gmail.com
Deadline for Application: February 18, 2008
 Key Club International Scholarship Application
Submit to Key Club District
Use this form if District does not have a form. Submit only one application per student.
Check all scholarships for which you want to be considered.
Key Club International Youth Opportunity Fund Scholarship
Himmel Scholarship Party for a Purpose Scholarship
Robert Thal Scholarship District Scholarship
Stephen Sapaugh Scholarship Other:
______ TruGreen Scholarship (must include 200-word essay of campus/community beautification project;
signed by Key Club Advisor)

Name Key Club Member Number

First middle last

Birth Date (mo/day/year) Gender: Female Male

Permanent Address
Street Address

City State/Province Postal Code Nation

Home Phone with Area Code / E-mail Address
Grade Point Average/Scale
Parents’ Names
High School Key Club District
Key Club Faculty Advisor Name
Advisor Phone with Area Code / E-mail Address
UNIVERSITY INFORMATION
I have not finalized my decision as to which school I will be attending in the fall.
I will be attending the following school
(The scholarship check will be mailed directly to the school’s Financial Aid or Scholarship Office. Please secure the
address of this office.)
University Name:
To which office the check should be mailed:
Address:
Campus Address

City State/Province Postal Code Nation

Phone Number with Area Code / E-mail Address
HOMETOWN NEWSPAPER ADDRESS
Name of Hometown Newspaper
Address:
Street Address

City State/Province Postal Code Nation

E-mail Address

SIGNATURES
Applicant Printed Name

Key Club Advisor Printed Name

Parent Signature: Printed Name

Key Club Offices & Leadership Events: (elected or appointed positions on the club, district or International
level. Also list any district/International conventions, training conferences, or leadership events attended)

Campus Organizations & Activities:

Religious & Community Activities:

Honors, Awards & Special Recognition:

Attach two recommendation letters that describe your leadership ability: one from a Kiwanis club member
or your Key Club Faculty Advisor, and one from a community or religious leader. The reference letters
must be no more than two pages in length, and they must be original letters that are dated and signed by
your references.

Attach a certified a copy of your official high school transcript with an explanation of the grading process
utilized at the school.

If you are applying for the TruGreen Scholarship, please attach a 200-word essay on a campus/community
beautification project that you worked on. It must be signed by your Faculty Advisor.

Scholarship applications MUST BE POSTMARKED BY YOUR INDIVIDUAL DISTRICT

DEADLINE, and mailed to YOUR DISTRICT’S REPRESENTATIVE!
 Cunat International Scholarship

While serving as governor of the Illinois-Eastern Iowa District in 1992-93, Brian

and Miki Cunat established this scholarship, to recognize and support Kiwanis-
Family members who were setting out to make a difference in people’s lives as
they worked their way through school.
The Cunat’s have been believers in setting goals, staying the course, and accomplishing their goals.
Life goals should be not only self serving, but include the concept of helping others and making the
world a better place for all.
During 2001-02, serving as Kiwanis International President, Brian and Miki Cunat expanded the
scholarship program to include other parts of the world. Their love for children and young adults,
and their beliefs that our future is in their hands motivates them to fund these scholarships.
Together we can “Build Today for Tomorrow’s Dreams.”
One US$2,500 scholarship for a college-attending Key Club International member.

Name
First Middle Last

Permanent Address
street address

city state/province zip/postal code nation

Home Phone with Area Code / Gender: Female Male

Parent’s Names

E-mail Address

Grade Point Average/Scale Major

University Planning to Attend

To which office the check should be mailed:

Address:
campus address

city state/province zip/postal code nation

Phone with Area Code / E-mail Address

1. Please list Kiwanis Family involvement. (K-Kids, Builders Club, Key Club)
2. Other organizations and activities you have been involved with:

3. Attach a 200-word essay describing how your studies will help you achieve your
goals while benefiting the lives of others.

4. Attach two letters of reference originally signed and dated and no more than two
pages in length, that describe how you are beginning this “life to benefit others.” The
letters should be from a Kiwanis or Faculty Advisor to the Key Club, and a fellow
Key Club member.

Required Signatures

Applicant: Printed Name

Kiwanis Advisor: Printed Name

This scholarship application must be submitted by April 15, 2008 directly to:
Brian and Miki Cunat, 5400 W. Elm Street, Suite 110, McHenry, IL 60050
 David Hancock Scholarship Application
The David Hancock Memorial Scholarship is funded by family and friends in memory of
deceased Kiwanian and Key Club supporter David Hancock. Applicants must submit this
completed application, along with two letters of reference, and can attach no more than 10
pages of supporting documentation (including photographs, newspaper clippings, etc.). The
supporting materials must be limited to 8-1/2 x 11-inch pages. Applicants must also submit a
500-word essay (topic explained below). The address to submit this packet is at the end of this
application.

Name Gender Female Male

Home Address
Street

City State/Province Postal Country

Home Phone with Area Code / E-mail Address

Grade Point Average/Scale Class Rank/Class Size

Parents’ Names

High School Key Club District

Birth Date (mo/day/year)

SIGNATURES

Applicant Printed Name

Key Club Faculty Advisor Printed Name

Applicant’s Parent Printed Name

Key Club Offices & Leadership Events Attended:

Key Club Service Work Completed:

High School Activities, Leadership Experience:

Community Activities, Leadership Experience:

Awards & Honors Received:

Essay Question: How has your involvement with Key Club shaped your approach to
leadership? Attach this 500-word essay to your application.

Attachments: You may attach no more than 10 pages of supporting documentation (including
photographs, newspaper clippings, etc.). The materials must be limited to 8-1/2 x 11-inch
pages.

Submit this application postmarked by April 1, 2008 to Jeff Hancock, 3481 Lakeside Dr. NE
Unit 2605, Atlanta, GA 30326-1338
 Kappa Alpha Order’s “joinKA.com Scholarship”
2008 Application

Name
First Middle Last

Present Address
Street Address

City State/Province Postal Code Nation

Telephone with area code / E-mail Address

Mailing Address after 6/1 (if different)

Street Address

City State/Province Postal Code Nation

Telephone with area code /

Age Date of Birth (mo/day/year)

Institution in which you expect to enroll for Fall 2008

Have you already been admitted to the above institution?

What type of degree will you be working toward? [ ] undergraduate [ ] professional

List extracurricular activities in high school.

(next)
What are your plans for the future?

List summer and academic-year jobs that you have held in the past four years.

I hereby certify that all information in this application is true and accurate. I
understand that forgery of any signature or intentional misrepresentation herein will
result in the disqualification of my application and possible disciplinary proceedings.
Further, I understand that deviation from the academic plans outlined herein may
result in a review by the scholarship committee of any grant awarded.

Signature of applicant:

Date:

Questions about this scholarship may be directed to Jesse Lyons,

Director of Chapter Development, Kappa Alpha Order,
PO Box 1865, Lexington, VA 24450
Phone: 540/463-1865; Fax: 540/463-2140; E-mail: jlyons@ka-order.org

Application deadline: Submit to Kappa Alpha Order

to the address above no later than May 31, 2008.

October 2007
Key Club International
A Kiwanis Service Leadership Program