Silverton High School



505968048260009144048260Silverton ScholarshipApplication and Instructions(Award for School Year 21-22)00Silverton ScholarshipApplication and Instructions(Award for School Year 21-22) Please use the following check list to ensure your application is complete:457208572500All sections and all blanks in the application must be completed. Applicants that do not use this specific form or exact duplicate are at a disadvantage.685801524000Anticipated budget for the next academic year (both resources and costs) must be completed and balanced with equal totals.6858015113000Application must be signed and dated.666755651500You must attach copy of your complete and current SHS transcript (front and reverse). An “unofficial” copy of your SHS Transcript is acceptable. Also - any and all other additional academic transcripts (e.g. Chemeketa) completed while a student at SHS. AND3810010858500Graduating seniors – You must submit your complete Application packet to directly to Christy Chorazy, SHS Scholarship Coordinator, no later than 3 p.m. on March 15, 2021. Letters of recommendation are not required or accepted.2095525590500ORPost High School applicants – In addition to the required unofficial copy of your Silverton High School transcript you must provide OFFICIAL copies of ALL your College transcript(s) including the current enrolled In-process term of the current year. All transcripts must be included with this Application. Unofficial copies from Student or online accounts are not acceptable. AND:Post High School applicants must either submit this application and attached transcripts through the mail with a postmark no later than March 15, 2021 or deliver it by that date directly to Mason Branstetter, Silverton Realty, 303 Oak Street, Silverton, OR 97381. If possible, get the applications to Mason earlier than the due date. If he notices a problem, he may be able to contact you prior to the closing date for you to make the necessary corrections. Your application has to be complete, signed, dated and timely submitted to be considered on its merits. Do not send to or through SHS.1160145183515KEEP this Cover Sheet for your records.Be certain to Submit pages 1 – 4 as your Application00KEEP this Cover Sheet for your records.Be certain to Submit pages 1 – 4 as your Application4709160-8382000965200-83820Silverton ScholarshipApplication(Award for School Year 21-22)00Silverton ScholarshipApplication(Award for School Year 21-22)High School graduating seniors’ applications will be accepted by Christy Chorazy, Scholarship Coordinator at Silverton High School at the Administration Officeno later than 3 PM on March 15, 2021. Post High School applications will be accepted if postmarked or delivered directly to Mason Branstetter, Silverton Realty, 303 Oak St, Silverton 97381 by March 15, 2021.This application is to be used by qualified applicants who are graduating or have graduated from SHS and desire to apply for SHS Alumni Association scholarship awards to include: Craig and Gladys Clark; Phil Clites; Glen Damewood – Wooden Nickel; Bill Dibala; Clarence and Norma Medack; P.A Loar; Errol and Eaden Ross; and Doug Strom Scholarships.Awards will be granted only to Silverton High School graduates who will be attending full time as an undergraduate student, any public or private post-high school educational/vocational institution in the United States for the full academic year. Alumni with Bachelor’s Degrees are ineligible.Please print, type or word process (If you choose to word process then please keep this format.) A word.doc file is available at: or email: mason@ Name: __________________________________________________________Permanent__________________________________________________ mailing Street or P O Box address: __________________________________________________City StateZipE-mail address: _____________________________________________________Telephone number: __________________ Social Security: Upon Request.Cell phone: ________________Year of graduation from Silverton High: ________Mailing address of ___________________________________________________ School you plan Name to attend: ___________________________________________________ Street or P O Box___________________________________________________City StateZipMajor Field of study: ____________________________________________________Expected college graduation date: _______________Applied for admission? ____ Yes ____No Have you been accepted? ____ Yes ____NoCurrently attending college full-time? ____ Yes ___ No Currently attending college part-time? ____ Yes ____ NoCOMPLETE THE FOLLOWING:Brothers and sisters (please include a statement of their current activities, i.e., student, living at home, college, etc.)________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________Father’s name: __________________________________________________ Occupation: ____________________________________________________Mother’s name: _________________________________________________Occupation: ____________________________________________________Your work experience:Your Career goal(s):School and community extracurricular activities in which you have participated during the present and previous three years, please note whether in HS or college: Example015240Frosh Soph Jr Sr Football C__HS__HS__Hospital Auxiliary _ HS__HS__HS__Band C __HS____HS__00Frosh Soph Jr Sr Football C__HS__HS__Hospital Auxiliary _ HS__HS__HS__Band C __HS____HS__Note: Post HS and pre-College activities can also be entered into a column as PHS.ActivityFroshSoph Jr Sr(HS, C)(HS, C)(HS, C)(HS, C)_______________________ _______________ ____________________________ _______________ ____________________________ _______________ ____________________________ _______________ ____________________________ _______________ ____________________________ _______________ ____________________________ _______________ ____________________________ _______________ ____________________________ _______________ ____________________________ _______________ ____________________________ _______________ ____________________________ _______________ ____________________________ _______________ ____________________________ _______________ ____________________________ _______________ _____ANTICIPATED BUDGET FOR SCHOOL YEARTotal expected resources and total expected costs MUST EQUAL each other. Anticipated ResourcesExpected CostsPersonal savings through May_____________Tuition and fees . . . . . . . _____________Expected summer earnings _____________Room and board . . . . . . _____________ Planned family contribution _____________Books & supplies . . . . . . ._____________Projected school year earnings _____________Laundry & dry cleaning _____________Scholarships/Grants Medical premium/costs _____________already guaranteed _____________Car payments & costs.. ______________Anticipated funds from loans,grants, scholarships, etc.Transportation costs . . . ______________(Provide names and amounts)Other (specify) . . . . . . . . ___________________________________ _______________________________ . . . . ___________________________________ _______________________________ . . . . ___________________________________ _______________________________ . . . . _____________Additional funds needed _______________ Total Required Resources _________________ = Total Projected Costs ________________I BELIEVE ALL OF THE INFORMATION IN THIS APPLICATION AND THE ATTACHMENTS IS TRUE. I HAVE READ AND AGREE TO BE BOUND BY THE TERMS OF THE SCHOLARSHIP AND I AGREE THAT IF I DO NOT ATTEND AS A FULL TIME STUDENT AT AN ACCREDITED INSTITUTION IN THE UNITED STATES FOR A COMPLETE SCHOOL YEAR THAT I WILL RETURN THE AWARD. SIGNED: ___________________________________ DATE:____________(APPLICANT)center8890Admin processing notes:Received before March 15th Deadline Y NRec’d ________________Balanced Budget: Y N HS transcript unofficial (required for all): Y NPostmarked ___________All College Transcripts Official: Y N NAComplete Application: Y N Completed_____________Social Security Number: Upon RequestIf incomplete and time permits contacted applicant via (email / phone) for corrections ____________________________________________________________00Admin processing notes:Received before March 15th Deadline Y NRec’d ________________Balanced Budget: Y N HS transcript unofficial (required for all): Y NPostmarked ___________All College Transcripts Official: Y N NAComplete Application: Y N Completed_____________Social Security Number: Upon RequestIf incomplete and time permits contacted applicant via (email / phone) for corrections ____________________________________________________________ ................
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