High School Senior
OMRO AREA SCHOLARSHIP AND EDUCATION PROGRAM
LOCAL SCHOLARSHIP APPLICATION FORM
Applications Due March 12, 2015
Type or print legibly – Answer all questions
Name
Address City
Zip Code Phone Number Date of Birth
1. Name of father /guardian: Occupation/Company:
2. Name of mother/guardian: Occupation / Company:
3. Parents divorced? Mother or Father deceased? Other status?
4. Number of children claimed as dependents on income tax form? List ages:
5. Number of family members attending college (including yourself):
6. Do you have family members who are veterans? Y N If yes, who?
7. Do you have a family connection to agriculture? Y N If yes, how?
8. Postsecondary school you plan to attend:
9. Intended major:
Activities
List your school and community extra-curricular activities and the years in which you participated. List all offices held, honors, awards, etc. If you need more room, please use a separate sheet of paper.
Activity
/Year(s) 9,10,11,12
/Offices/Honor/Awards
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.
· Describe a unique quality or an accomplishment that you are most proud of.
· Describe how you have given back to the community through volunteer work, community learning, and/or a part time job.
· 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 required – Do not type signature)
______
Student Signature Parent/ Guardian Signature Date
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Due to the variety of criteria that is listed for the various scholarships being offered through the Omro High School, please indicate by placing a checkmark before any or all of the scholarship(s) that you feel you are qualified for or interested in
Laura & Warner Bohn Memorial Scholarship Omro Alumni Association Scholarship
Marie Bullis Barnard Scholarship Omro Athletic Booster Club - General
Karen Butkiewicz Memorial Scholarship Omro Athletic Booster Club – Lois Sperger
Stanley Butkiewicz Scholarship Omro Athletic Booster Club – Robert Newhouse
Cans for Kids Scholarship Omro Education Association Scholarship
Casa Esther Scholarship Omro FFA Alumni Scholarship
Donald (Joe) Dailey Scholarship Omro Masonic Lodge #168 Scholarship
Ferne Davis Scholarship Omro Area Scholarship & Educ Fdn
Vincent K. Derscheid Scholarship Omro Thrift Store Scholarship
Lewis Drobnick Scholarship Omro Youth Wrestling Scholarship
First National Bank Scholarship Omro Women’s Service League Scholarship
Bruce Fowler Memorial Scholarship OOMPA Music Scholarship
Gene E. Giddings Scholarship Lylalu Treleven Paffenroth Scholarship
Coach Goss & Kathryn Goss Scholarship Edward J. Pierce Family Scholarship
Rosie & Don Hildebrand Scholarship Red Arrow Club Scholarship – extra essay
Shirley Hintz Memorial Scholarship Reitz-Wegner Scholarship
Wilber Hurlbut Scholarship Rew-Ross Memorial Scholarship
Raymond Janiak Scholarship Lowell Rolph Scholarship
Les Kallas Memorial Scholarship Saint Mary Parish Education Award
Charles & Margaret King Scholarship Maurice J. Schoenbechler Scholarship
Kiwanis Scholarship Jason Tanner Memorial Scholarship
G & H Kleinschmidt Scholarship Royal and Della Tice Scholarship
Brian Lee Memorial Scholarship Mildred E. Turner Scholarship
Dan Martin Memorial Scholarship Paul Ulrich Scholarship
Messiah Evangelical Lutheran Church Craig Wesner Scholarship
My Opportunity Scholarship James C. Will Scholarship
American Legion Post 234 Scholarship Helen and Neal Wright Scholarship
Young Minds Change Lives Scholarship