Microsoft Word - Document1

Floyd&ElizabethCulverMemorialScholarship

2021Application

TheFloyd&ElizabethCulverMe

morialScholarshipFundwasestablishedforthepurposeofawardinga

four‐yearscholarshiptoapublicTillamookCountyHighSchoolgraduatingseniorwhowillbeattending

aninstitutionofhighereducation withintheStateofOregon.OneScholarshipwillbeawardedeach

year.

TheScholars

hipisawardedonacombi

nationofmerit,financialneed,moralcharacterandwhomight

finditdifficulttoattendcollegewithoutthehelpofascholarshiporotheroutsidefinancialassistance.

Thecandidatemustshowevidenceofaneducationalgoal.Selectionismadebyacommitteeand the

decisionofthecommitteeisfinal.

CompletedApplicationsDuebyMonday,August2,2021.

Thefollowingitemsmustbepresentforanapplicationtobeconsideredcomplete:

COMPLETEDAPPLICATIONFORM:

CURRENTHIGHSCH

OOLTRANSCRIPT:

FAFSA‐FEDERALSTUDENTAID:Pleaseattachacopyofyour“ComputedInformationPage”

fromtheFreeApplicationforFederalStudentAid(FAFSA),ifyoufiledonline,oracopyofpage

oneofyour“StudentAidReport”ifyoufiledyourFAFSAbymail.AllFinancialinfor

mationis

keptstrictlyconfidential.

LETTERSOFRECOMMENDATION:Pleaseattachlettersofreferencefromtwopeoplewhoknow

you,includingonewhoisknowledgeableaboutyoureducationalaccomplishm ents(teach).Do

notincludeanyrelatives.

PERSONALSTATEMENT(Essay):In250wordsorless,pleaseattachanessaytellingthe

commi

tteewhyyouareap

plyingforthisscholarship.Pleaseincludeacademicandorpersonal

achievementsthatwillsupportyourapplication.

Contact Information:

U S Bank Private Wealth Management

Jennifer Lessard Stoltey

800 Willamette Street Suite 200 Eugene OR 97401

Fax: 541-465-4076

Phone: 1-800-922-0678

E-Mail: [email protected]

Floyd&ElizabethCulverMemorialScholarship

2021Application

APPLICANTNAME:_____

________________________________________________________________

HOMEADDRESS:______________________________________________________________________

_____________________________________________________________________________________

EMAIL:_______________________________________________________________________________

PHONE:_____________________________________DATEOFBIRTH:__________________________

GENDERATBIRTH: Male Female

PARENT(S)/GUARDIANNAME:___________________________________________________________

PHONE:_________________________________EMAIL: _______________ _______________________

NAMEOFHIGHSCHOOL:________________________________________________________________

YEAROFGRADUATION:__________AREYOUATILLAMOOKCOUNTYRESIDENT?YesNo

HAVEYOURECEIVEDACOLLEGEACCEPTANCE?Yes

No P

ending______________

COLLEGEYOUWILLBEATTENDING:_______________________________________________________

INTENDEDCOURSEOFSTUDY:___________________________________________________________

INTENDEDCAREER:____________________________________________________________________

STUDENTHONORS,AWARDS,ANDDISTINCTIONSANDDATESRECEIVED:________________________

_____________________________________________________________________________________

COMMUNITYANDEXTRACURRICULARACTIVITIES:__________________________________________

_____________________________________________________________________________________

CURRENTEMPLOYMENT:_______________________________________________________________

FUNDINGSOURCES:Areyoupresentlyorwillyoubereceivinganyothers

cholarship,grantorstipend?If

so,Listnameofyourdonor(s)andtheamount(s)forthenextschoolyear:____

____________________

_____________________________________________________________________________________

Floyd&ElizabethCulverMemorialScholarship

2021Application

ESTIMATEDSCHOOLINGCOSTSFORNEXTACADEMICYEAR:

Tuition: ______________

Books&Supplies: ______________

Room&Board: ______________

Miscellaneous: ______________

Total: ______________

TESTIMONYANDSIGNATURE:IherebyattestthatIunderstandtheawardtermsandthattheforgoing

informationprovidedbymeistrusttothebestofmyknowledge.

Signature:___________________________________________ Date:____

_______________________

ReturncompletedapplicationandattachmentsbyMondayAugust2,2021to:

USBankPrivateWealthManagement

JenniferLessardStoltey

800WillametteStreetSuite200

EugeneOR97401

Fax:541‐465‐4076

1‐800‐922‐0678

E‐Mail: [email protected]

CHECKLIST:Thefollowingitemsmustbepresentinorderforanapplicationtobeconsidered

complete:

COMPLETEDAPPLICATIONFORM:

CURRENTHIGHSCH

OOLTRANSCRIPT:

FAFSA‐FEDERALSTUDENTAID:Pleaseattachacopyofyour“ComputedInformationPage”

fromtheFreeApplicationforFederalStudentAid(FAFSA),ifyoufiledonline,oracopyofpage

oneofyour“StudentAidReport”ifyoufiledyourFAFSAbymail.AllFinancialinf

mationis

keptstrictlyconfidential.

LETTERSOFRECOMMENDATION:Pleaseattachlettersofreferencefromtwopeoplewhoknow

you,includingonewhoisknowledgeableaboutyoureducationalaccomplishm ents(teach).Do

notincludeanyrelatives.

PERSONALSTATEMENT(Essay):In250wordsorless,pleaseattachanessaytellingthe

commi

tteewhyyouareap

plyingforthisscholarship.Pleaseincludeacademicandorpersonal

achievementsthatwillsupportyourapplication.