Scholarship Funds Request Form

"*" indicates required fields

Awarded by Rotary Club of Dearborn

To apply for funds from your scholarship award, you MUST complete this form in full.

No scholarship funds will be processed until July 1 of the year in which you receive your award. Funds for your award will only be available until June 30 of the following year. Funds will be available for an additional year for Collegiate Academy students who receive the award in their senior year of High School. Any unclaimed scholarship monies will be returned to the Foundation’s respective scholarship fund.

All checks will be sent to the college or university you are attending, and will be made payable to you and the college. Otto J. Rowen Scholarship winners, see footnote at bottom of page for possible exception.

Scholarship Recipient's Full Name*

First Last

Home Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone Number*

Email Address*

Amount of Scholarship Award*

School Year Awarded*

Name of Scholarship Awarded: Select the Appropriate Scholarship(s)*

Name of College or University*

Address of College or University Financial Aid Office*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

College or University Student ID #*

*Otto J. Rowen scholarship recipients who do not attend college and plan to use scholarship funds to purchase specialized equipment needed for related vocational programs, please describe below what the funds are to be used for along with the name to whom the check should be made payable. A copy of the detailed purchase receipt must be submitted for reimbursement of approved equipment purchases.

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Max. file size: 96 MB.

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