CHAPTER FL, OREGON P.E.O. SCHOLARSHIP

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1 This scholarship will be available to any woman attending any higher education institution showing strength of character, commitment, and dedication to a goal, with preference given to those either dually enrolled in Central Oregon Community College and OSU Cascades or to women enrolled in any of the OSU Cascades undergraduate or graduate programs. A woman is eligible to apply if she: Is studying in the United States Is a high school graduate or equivalent Is enrolled in or has been accepted into any higher education program, with preference given to women who are either dually enrolled at COCC or enrolled in any of the OSU-Cascades undergraduate or graduate degree programs Financial need will be considered A woman is ineligible to apply if she is related to a current member of the Chapter FL Scholarship Committee. Application Form Completed in Full Form Signed and dated Income and Expense Statement Application Checklist Completed in full for the time period of one term or semester Include explanations of any unusual entries Show total educational loan debt that has been used not what is available Signed and dated by applicant One Letters of recommendation by current or past professors Signed in sealed envelope Personal statement and essay Transcripts (unless applicant has had a break in her education of two years or more) Please return all completed forms by May 15 th, 2013 to: Ann Fleck 1385 NW Promontory Drive Bend, OR If you have any questions, feel free to call: Ann at

2 APPLICATION FOR SCHOLARSHIP PERSONAL INFORMATION Name: Age: Birth date: Home Address: Phone Number: Ages of Dependent Children: Marital Status: INSTITUTION TO BE ATTENDED Institution: Academic Year:

3 Address of Institution s Business Office: Major/Focus: Standing at start of Term/Semester: Projected Date of Completion: Cumulative G.P.A.: Educational Goals/Career Plans: EDUCATIONAL HISTORY Colleges/Institutions: Years: Degree Earned: High School: Year Graduated: The information on this application, financial statement and personal essay are accurate and true to the best of my knowledge. If I receive a scholarship from Chapter FL, Oregon P.E.O. Scholarship, I give permission to release my name, name of college, year in college, and major to the local newspaper; and for use on its web site, bulletin boards, and/or newsletters. Please initial here if you do not want release of any information about this scholarship. Signature: Date:

4 Income And Expense Form MONTHLY INCOME MONTHLY EXPENSE Rent/Room/Campus Board After Tax Salary: Applicant Mortgage Payment Spouse Other in household Financial Aid (Actual per month) Scholarships/Grants (list) Food/Groceries Utilities Clothing Telephone Medical/Dental Automobile Payment Educational Loans (list) Expense Insurance Loan/Charge Card Payments (list) Child Support/Alimony State, U.S. Government Assistance (List Source) Childcare (not related to education) Other (list): Food Stamps Savings/Interest/Dividend Other Income (list) TOTAL MONTHLY LIVING EXPENSE Number of Months Per School Term Total Educational Expenses TOTAL MONTHLY EXPENSES TOTAL MONTHLY INCOME EDUCATIONAL EXPENSE PER TERM/SEMESTER ADDITIONAL INFORMATION Tuition Books/Educational supplies Childcare related to education Transportation (gas, parking, bus fare) Total in Saving Accounts Total in Investments Current Educational Loan Debt Total Balance of Other Indebtedness Other (list) TOTAL EDUCATIONAL EXPENSES SIGNATURE: DATE:

5 Personal Statement 1. List education, work, volunteer experiences and honors received. Please include amount of time devoted to each. 2. Why should this scholarship be given to you over other qualified candidates?

6 Essay Please choose one topic from the following and discuss in 250 words or less. Evaluate a significant experience, achievement, risk you ve taken, or ethical dilemma you have faced and it s impact on you. Discuss some issues of personal, local, national, or international concern and it s importance to you. Indicate a person who has had a significant influence on you and describe that influence. Describe a character in fiction, historical figure, or creative work as in art, music, science, etc that has had an influence on you and explain that influence. As you reflect on life thus far, what has someone said, written, or expressed in some fashion that is especially meaningful to you, why? Describe a challenge you have overcome.