Dr. Dick Alan Bergren Cryonics Suspension Trust

Bruce E. Swanson, Michael D. Boylan, Winfield G. Mayne, Trustees

Post Office Box 468, Red Oak, IA 51566-0468

Bergren Science/Technology Scholarship

Due: April 1

Purpose of Scholarship

To Promote a Course of Study in the Fields of

Science, Technology, Physics, Chemistry, or Mathematics

Scholarship Amount

The intent of the Bergren Scholarship is to provide a single annual scholarship or Scholarships in an amount not to exceed $5,000.00 per individual. Amount is subject to revision, to be increased or decreased at the discretion of the Trustees of the Bergren Trust.

Qualifications and Terms for Application

High School Students who reside in Montgomery County or attend High School in Montgomery

County are eligible to apply. This includes students from Montgomery County attending surrounding school

Districts.

The focus of the scholarship is to promote learning in specific fields of study related to the sciences. The primary emphasis in selection of the final applicant will not be placed on academics or academic standing but more on the course of intended study being pursued by the applicant. Financial status of parents, family or applicant will be considered secondary to the potential skills of the applicant in the chosen field of study.

Scholarship funds will be distributed fully and directly to the account of the recipient with the indicated

School or institution of study prior to or at the time student attends.

Submission of Applications

Applications will be accepted by the Scholarship Trustees at the address above during the months of

March and April of each calendar year with an award being then announced in the month of May following

submission. Applications must be on the form provided by Trustees and are available from area schools or upon

request to the address above. Notification of final selection in the current year will be made directly to the

recipient or recipients with notification of the award being forwarded to all applicants and schools simultaneously.

Supplemental Information

It is beneficial to the applicant to include a transcript of courses taken and completed from their respective school as well as information related to any athletic, community, civic or outside activities the individual may have been involved with over prior years that would not be listed or shown on the students official transcript.

Bruce E. Swanson, Michael D. Boylan, Winfield G. Mayne, Trustees

Bergren Science /Technology Scholarship Application

Dr. Dick Alan Bergren

Applicant Name :

Address :

Address

City, State, Zip :

Phone Numbers to Contact Applicant:

High School Attended:

College or alternate schools attended :

Present or Planned Field of Study and Institution or School if accepted or enrolled.

Supplemental Information Attached

1. Academic Transcript

2. Personal statement from student detailing future educational plans and goals.

DO NOT include commentaries from teachers.

______

Signature of Applicant Date Signed

Please send applications by April 1st to: Dr. Dick Bergren Cryonics Suspension Trust

c/o Winfield Mayne

P.O. Box 468

Red Oak, Iowa 51566