Orange Scholarship Fund

Student Application Form

Name of Applicant Date of Birth


Phone No Social Sec. No.

Work Experience - (1) Place of work (2) Duties (3) Dates

1 2 3

1 2 3

1 2 3

Brief statement concerning your education goal :

Do you plan to work while attending college? Yes No

College/University applied to:

College/University accepted to:

Intended major - if known:

What have you done to acquire information/experience in the above area of interest? If area of interest in unknown at this time, leave blank.

What do you hope to achieve by enrolling in your post-secondary school?

Name of other scholarships or financial aid programs you have or will apply for:

Name of other scholarships or financial aid programs you were awarded and dollar amount:

Your current total savings /investments (include bank accounts, stocks, bonds)


Anticipated earnings this summer: $

Financial aid needed for the coming school year: $

Of all the students who will apply for financial assistance through the Orange Scholarship Fund, why should you be selected?

Note: If there is any additional pertinent information that would aid the committee in its deliberations please attach a separate sheet.

Student Additional Pertinent Information Form

To be completed by the student if needed

I certify that the answers given above are complete and accurate.

Student's signature Date 01-29-2020