Las Vegas Southwest Rotary Club
John and Lou Yoxen Academic Scholarship
2023
Application Form for 2021
Each year, the Las Vegas Southwest Rotary Club awards one $9,600 Academic
Scholarship to a graduating senior from Clark County, Nevada. Applications are
limited to those who intend to attend a public college or university in Nevada, i.e.
UNLV, UNR, Nevada State Collete, College of Southern Nevada or other public
college in Nevada. The scholarship is payable on a per-semester basis ($1,200 per
semester) and is renewable for up to 7 semesters of college as long as the applicant
maintains a 3.0 GPA (on a 4.0 GPA maximum) and completes a minimum of 12
semester hours per semester. The scholarship will be paid directly to the school you are
attending for your account.
Required eligibility requirements:
1. Graduating from a high school in Clark County, Nevada
accredited by the Northwest Accreditation Commission
2. A minimum cumulative 3.25 GPA.
3. Demonstrate a family or student financial need.
Desired eligibility requirements:
1. A minimum composite ACT score of 22 or a SAT score of
1100, if you did not take either the ACT or SAT please attach a
statement elaborating what circumstances restricted or
prevented you from taking those exams
2. Demonstrate leadership in school and/or community.
3. Must be a legal resident of the United States
To apply for the scholarship for 2023, please send the completed scholarship packet postmarked by
April 1, 2023:
1. Application form
2. A recent photo
3. Financial need statement
4. Seven semester official transcript, including recent national test scores
5. Two letters of recommendation from other than a relative
6. A minimum 750 word essay on the topic “Why Las Vegas Southwest
Rotary should award me this scholarship”
Incomplete and late applications will not be considered; please review your
application carefully before your submission to:
Las Vegas Southwest Rotary Club
Scholarship Committee
PO Box 752612
Las Vegas, NV 89136
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Application Form for 2021
Las Vegas Southwest Rotary Club
John and Lou Yoxen Academic Scholarship for
2023
STUDENT INFORMATION
Name of applicant __________________ __________________ ____
Last First M.I.
Social Security Number ______________ Date of birth___________
Address __________________________________________
__________________ ________________ ______
City State ZIP Code
High School of Enrollment_____________________________________
Parent or Guardian ____________________Relationship___________
Address __________________________________________
(if different from applicant)
__________________ ________________ ______
City State ZIP Code
Home phone _________________ Cell phone __________________
Email address where you can be reached _________________________
Are you a U.S. Citizen_____ if no, are you an eligible non-citizen_____
List your Alien registration number A__________________
Please list all post high school institutions that you have applied to:
____________________________________________________________
____________________________________________________________
____________________________________________________________
Please list all scholarships and/or grants that you have applied for
and/or received:
_____________________________________ _________________
Signature of Applicant Date
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Las Vegas Southwest Rotary Club
John and Lou Yoxen Academic Scholarship
2023
Application Form for 2021
Student Profile
Community Service – list the volunteer work you have completed during
high school. Indicate the service organization and what you did.
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
Leadership in high school – list all positions you have held including the
year. You can describe what you did in those leadership roles.
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
Awards and Honors – list all that you have received in high school and
indicate what your grade level was when the award/honor was received.
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
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Las Vegas Southwest Rotary Club
John and Lou Yoxen AcademicScholarship
2023
Application Form for 2021
Work history (if applicable) please list place of employment, duties and
hours worked
Financial Need Statement
Parent or guardian of applicant:
__________________ __________________ ____
Last First M.I.
Occupation ___________________ Employer ____________________
Parent or guardian of applicant (other parent or guardian if working):
__________________ __________________ ____
Last First M.I.
Occupation ___________________ Employer ____________________
Copy of your parent(s) most recently filed Income Tax return
including schedules; please black out the social security numbers on
the copy of the return.
Other income source(s), besides the scholarships and grants listed on
page 2, that you will use towards your college expenses:
Amount ___________ Source _________________________________
Amount ___________ Source _________________________________
Are there other members of your family currently attending college?
_____________
Yes / No
Number of children in your family, including applicant ____________
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Application Form for 2021
Las Vegas Southwest Rotary Club
John and Lou Yoxen Academic Scholarship
2023
Please add any information you feel will strengthen your candidacy for
this scholarship.
____________________________________________________________
____________________________________________________________
____________________________________________________________
Parent or guardian signature Date
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