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Oregon Pacific Bank Scholarship Application 2019-2020
Submitter Information (Required)
First Name (required)
Last Name (required)
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Oregon Pacific Bank Scholarship

This scholarship was established in 1981 to encourage and recognize outstanding high school seniors in our communities. Six scholarships are awarded annually. Applicants must be in the current year graduating class in the following schools or geographic areas: Siuslaw High School (Florence, Oregon), Mapleton High School (Mapleton, Oregon), Douglas County, Coos County, Jackson County, Eugene/Springfield area.

*Applicants do NOT need to be a client of Oregon Pacific Bank to apply.

Eligibility Requirements

  1. Applicant must demonstrate intent to pursue either an academic or vocational career at an accredited college, university or vocational institution.
  2. Primary consideration in selecting the candidate will focus on leadership in community service or extra‐curricular activities while maintaining credible academic achievement.
  3. Applicant must present information on their financial need by submitting pertinent information to the scholarship committee.
  4. Applicant must provide the following documents with the application:
  • Grade transcript.
  • SAT scores and/or ACT scores (Not required for community college or trade school applicants).

One scholarship in the amount of $1,000 will be awarded to one student at each of the six communities listed above, and shall be paid directly to the student’s college, university or vocational institution. It is the student’s responsibility to provide the Oregon Pacific Bank Scholarship Committee (Attn: Deborah Kingry, P.O. Box 22000, Florence, Oregon 97439) with proof of enrollment in order for the scholarship to be paid. Failure to claim the scholarship within one school year will result in forfeiture.

 

Procedures

The Oregon Pacific Bank Scholarship Committee will inform the high schools of the scholarship availability. The scholarship will be publicized by the high schools.

Applications are due to the Oregon Pacific Bank Scholarship Committee no later than the first Friday in April. They can be completed online by filling out this form and submitting it online or printing this application and mailing or delivering it to: 1365 Highway 101, P.O. Box 22000, Florence, OR  97439. The Scholarship Committee will act on the applications; selection will involve an interview with the scholarship candidates.


The award is to be announced and presented according to each school’s method of presentation. The award will be accompanied by a letter of instruction detailing how the money will be disbursed for the benefit of the student.

Questions concerning this scholarship should be made to the Oregon Pacific Bank Scholarship Committee: 541.997.7121

PERSONAL INFORMATION
Cell #Home #Email
Contact Information (required) (required) (required)
Best method of contact
Mailing Address (required)
Please identify which geographical area your High School is located in to confirm eligibility (required)
PARENT/GUARDIAN INFORMATION
NamePhone #EmailOccupation
Mother
 

 

 

 
Father
 

 

 

 
Guardian (if any)
 

 

 

 
Best Mailing Address to Contact Parents or Guardian (required)
EDUCATION
You MUST include your GRADE TRANSCRIPTS and SAT and/or ACT SCORES (required)
Select Add a file to include required documentation.
Name of High SchoolGPA
High School Information (required) (required)
Address of High School (required)
Colleges/Universities/Vocational Schools under consideration, listed by priority
Institution NameLocation

 

 

 

 

 

 

 

 
Major Field of StudyExpected DegreeCareer Goal(s)
(required) (required) (required)
Are you currently working, or have you worked during high school? Please give us details on places of employment, duration, and type of work.
Place of WorkDurationType of Work

 

 

 

 

 

 

 

 

 
ESTIMATED ANNUAL COST of EDUCATION
Estimated $ Amount
Tuition and Fees (required)
Room and Board (required)
Books and Supplies (required)
Transportation (required)
Anticipated Personal Expenses (clothing, laundry, recreation, etc.) (required)
Unusual or major expenses for which applicant is responsible (required)
Total estimated financial need per year of college (required)
Other Resources
DetailsEstimated $ Amount
Scholarship(s)
 

 
Loan (s)
 

 
Savings
 

 
Family Financial Assistance
 

 
Work/Study
 

 
Employment
 

 
Other
 

 
If family cannot assist financially, please explain:
Siblings/others dependent on the family:
NameRelationshipAge

 

 

 
Please select one: (required)
ESSAY
Please provide a brief 4 paragraph maximum essay that shares information about you that is not evident in the rest of this application, including school experiences, community activities, honors to date, extracurricular activities, positions of responsibility, club, athletics, etc. (required)
ACKNOWLEDGEMENT
All statements in this application are correct to the best of my knowledge. (required)
Applicant Signature
Applicant NameDate of Application