Please fill out this form and submit it not later than Friday, November 1st. You will not receive your second semester check without submitting this form.

Please do not use initials or nicknames.
My personal cell phone number, including area code *
My personal cell phone number, including area code
Please note that we CANNOT accept email addresses which are associated with your high school or college. This must be a personal email address which you check yourself. If you don't already have one, we suggest getting a GMail email address.
Please don't use initials — provide the FULL name.
Please don't use initials — provide the FULL name.
Log into Facebook and go to your wall. Click at the top to copy the link which appears, and paste it here. If you are on Facebook, this is REQUIRED information. If you are not on Facebook, please write "not applicable" or "n/a" in this space.
Log into LinkedIn. Go to your account. Click at the top to copy the link which appears, and paste it here. If you are on LinkedIn, this is REQUIRED information. If you are not on LinkedIn, please write "not applicable" or "n/a" in this space.
If you attend a public high school other than those shown here but LIVE in one of the below districts, check the DISTRICT represented below. If your school doesn't appear in the list below, choose the last option and then see next question.
If your graduation year doesn't appear below, please email Marsha at TuitionMissionMLW@gmail.com with details.
You must include the branch if applicable (e.g., Kent State University/East Liverpool).
My housing plans for 2020 - 2021 are *
This ONLY refers to scholarships which DO NOT NEED TO BE REPAID. Do not include Pell or Promise grants.
This must be the amount you are receiving for the ENTIRE 2020 - 2021 academic year.
$
Just saying "Rotary" or "Rotary scholarship" isn't enough. "East Liverpool Rotary Club" scholarship would be correct. We need the full scholarship or grant name.
This must be the amount you are receiving for the ENTIRE 2020 - 2021 academic year.
$
Just saying "Rotary" or "Rotary scholarship" isn't enough. "East Liverpool Rotary Club" scholarship would be correct. We need the full scholarship or grant name.
This must be the amount you are receiving for the ENTIRE 2020 - 2021 academic year.
$
Just saying "Rotary" or "Rotary scholarship" isn't enough. "East Liverpool Rotary Club" scholarship would be correct. We need the full scholarship or grant name.
I understand that digitally "signing" this application by typing in my full name is, for all intents and purposes, identical to manually signing a paper application. By inputting my FULL NAME below as a signature, I am asserting that everything in this application follow-up is complete and accurate to the best of my knowledge. I understand that if I provide incorrect, incomplete or false information herein, it may result in my application being rejected; my tuition award (if I receive an award) being rescinded, in whole or in part; and/or my being disallowed from applying again in the future.