ELIGIBILITY:

Orange resident enrolled in public, private, parochial school entering his/her first year of post-secondary education.

TYPES OF QUALIFYING POST-SECONDARY EDUCATION:

Vocational, community college, four year college or university

REFERENCES:

Two references required (excluding relatives) - One must be from a school counselor or teacher

TRANSCRIPT: Transcript MUST be sent from your school. Speak to your guidance counselor to assure this is done by the deadline date (see Submission of Information below).

CRITERIA FOR SELECTION: Financial need - scholarship - leadership

LEADERSHIP ROLE(s) :

Complete the Leadership Role Form for only those groups, clubs, or organizations in which you have demonstrated leadership.

SCHOLARSHIP AMOUNTS AND DELIVERY OF SCHOLARSHIPS:

Past scholarships ranged between $500 and $1800 and were awarded among 6 to 9 students. Actual numbers are dependent upon the annual fund raising. Scholarship checks will be mailed to the post-secondary institution that the student will be attending.

DEADLINE DATE: May 1st. Late or incomplete applications will NOT be processed. Applicant is responsible for submission and verification of ALL requested information (references, transcripts, application forms) and mailing thereof by the due date.

Parents: Submission of your Federal Tax Form ( Pages 1 and 2 of Form 1040) is required to substantiate income data. All tax forms are maintained as confidential and destroyed soon after the scholarships are awarded.

Student Application Form

Name of Applicant Date of Birth

Address

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?

Student Additional Pertinent Information Form

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

To be completed by the student if needed

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

Student's signature Date