Post High School

OMRO AREA SCHOLARSHIP AND EDUCATION PROGRAM

LOCAL SCHOLARSHIP APPLICATION FORM

Applications Due February 24, 2017

Type or print legibly – Answer all questions

Name

Address City

Zip Code Phone Number Date of Birth

1. Name of father /guardian:

Address: Occupation/Company:

2. Name of mother/guardian:

Address: Occupation / Company:

3. Parents divorced? Mother deceased? Father deceased? Other status?

4. Number of children claimed as dependents on income tax form? List ages:

5. Are you a non-trad student (started college at least a year after high school)? Y N

6. Number of family members attending college (including yourself):

7. Postsecondary school you plan to attend next year:

8. Major/minor:

Activities

List your top 6 school and community (including employment) activities over the past 5 years. List the years in which you participated and the offices held, honors, awards, etc.

Activity

/

Year(s) 2014, 2016

/ /

Offices/Honor/Awards

*Please attach a college transcript to the application

Please write a 200-350 word essay in the space below that touches on the following points:

·  Describe why you are deserving of this scholarship.

·  What is your professional goal after graduation from a post-secondary school?

·  Describe how you have given back to the community as a volunteer and/or as an employee.

·  Please list any information that will help the committee judge your merits as a financial aid applicant.

I certify the above information to be true, correct, and complete. I understand that all the information will be confidential. (Original signature is required – Do not type signature)

______

Student Signature Date

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Please indicate by placing a checkmark before any or all of the scholarship(s) that you feel you are qualified for or interested in:

Omro Area Scholarship and Education Foundation

Omro Thrift Store

Strehlow Family

Clark Family

Completed applications need to be printed and returned to the high school guidance office by

Friday, February 24, 2017

Send applications to: Dianne Rosenthal, Guidance Secretary

Omro High School

455 Fox Trail

Omro, WI 54963