* 1. By typing my name below I affirm I am the Kiwanis International Foundation district chair for my district.

Transcription

1 Pre-qualifiying question * 1. By typing my name below I affirm I am the Kiwanis International Foundation district chair for my district. Pre-qualifying question * 2. I certify that I read the program guidelines for this scholarship program and understand my role as the primary contact for my district throughout the program. Yes No District chair information Kiwanis-family member authorized as the primary contact * 3. Name of your Kiwanis district * 4. Your first name

2 * 5. Your last name * 6. Your address * 7. Your telephone number (with dialing code) Recipient selection process * 8. Describe the selection process used to determine scholarship recipients. Include the selection criteria and information about the application and review process used by your district. Scholarship recipient information Information provided must match the student's school record exactly. To avoid delays in students receiving their scholarship payments, ensure you provide complete and accurate information. * 9. Recipient's legal first name (Do not use nicknames.)

3 * 10. Recipient's legal last name * 11. Recipient's date of birth MM DD YYYY Month / Day / Year / / * 12. Recipient's permanent address (Street address, city, state/province, postal code and country) * 13. Recipient's address * 14. Name of recipient's school * 15. Recipient's school student identification number * 16. Contact information of the office where private scholarships are processed at the recipient's school (Phone number and address) * 17. Mailing address of the office where private scholarships are processed at the recipient's school (If it is not possible for the foundation to mail the payment directly to the school, answer "N/A.") * 18. Is the recipient's school located outside of North America? Yes No

4 Additional student information 19. Has the recipient taken an English name? If yes, provide the recipient's English name and indicate which name he/she prefers. Payments for students attending school outside of North America * 20. What is the best method to pay this student's scholarship award? Check sent by the foundation to the recipient's school via postal mail Check sent by the foundation to the recipient's school via FedEx Payment sent by the foundation to the recipient's school via wire transfer Payment sent by the foundation to your district which will facilitate payment to the student Payment for a student attending school outside of North America 21. Provide any additional information necessary for the foundation to send the student's scholarship payment to his/her school. Payment for a student attending school outside of North America

5 22. Bank name 23. Bank's address 24. Bank's SWIFT code Beneficiary's information must be exactly as it appears in bank records. 25. Beneficiary's name on the account 26. Beneficiary's address 27. IBAN for beneficiary's account 28. Additional information needed to process the payment Payment facilitated by awarding district 29. What is the official method of payment from Kiwanis International to your district? Check sent via postal mail Check sent via FedEx Wire transfer to your district's official bank account

6 Address information for payment to the awarding district 30. Provide any additional information necessary for the foundation to send the payment to your district. Indicate if you prefer postal mail or FedEx delivery. Wire transfer information for payment to the awarding district Provide the information below to process the payment via wire transfer. 31. Name of bank 32. Bank's address 33. Bank's SWIFT code 34. District's name as it appears in bank records 35. District's address as it appear in bank records 36. IBAN for district's account