L2E-Application Form - The Rotary Club of Naples

GENERAL INFORMATION

Name

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Cell Phone

Other Phone

Email

Name of High School, Location and Date of Graduation

Other Post High Schools Attended with Location of School, Dates of Attendance and Degrees or Certificates Earned

Name of Alternate/Emergency Contact

Phone Number for Alternate/Emergency Contact

FAMILY INFORMATION : Name and Address

Address Line 1

Address Line 2

City

State

Zip Code

Name and Phone Number of Immediate Family Contact

Email of Immediate Family Contact

PERSONAL INFORMATION

How long have you lived in SW Florida? Where did you live previously? Why did you and you family move to SW Florida? Please be complete and specific.

What is your current and past work experience? Please list name and dates of employment.

What are some of the personal skills, abilities and attributes you believe you have that will assist you in your potential program and future employment?

DESIRED CAREER OR TECHNICAL PROGRAM INFORMATION

What is the type of carer or technical programdesired and where is the program offered?

What is the length of the program? When does it begin and end? What are the days and hours of attendance?

What is the status of your application to the career or technical program at the school in the previous question? When will a decision be made on your acceptance into the program? Please note that applications will not be considered until an application to a program has been submitted.

What is the total cost of the program, including tuition, books, fees, uniforms, tools/equipment and any other expenses? Please be specific for amounts in these categories.

Are the costs of the program the same for each term or different? If different, please provide details. Attach a financial sheet from the school if one is available.

What scholarships and/or grants are expected or have been applied for? Please list specific amounts from awards.

What is your financial need to complete this program?

How would you pay for the program or a portion of the program without financial assistance?

Please provide the names and contact information for the non-family persons you are asking to complete a letter of recommendation. List any other persons who could be contacted to provide information about you. Please note that two non-family letters of recommendation are required to be submitted with the application.

Additional Comments (optional)

Please provide Letter of Recommendation #1

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Please provide Letter of Recommendation #2

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