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Oregon Pacific Bank Scholarship Application
Submitter Information
First Name (required)
Last Name (required)
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Cell #Home #Email
Contact Information
Mailing Address (required)
Please identify which geographical area your High School is located in to confirm eligibility (required)
NamePhone #EmailOccupation
Guardian (if any)
Best Mailing Address to Contact Parents or Guardian (required)
Name of High SchoolGPA
High School Information
Address of High School (required)
Colleges/Universities/Vocational Schools under consideration, listed by priority
Institution NameLocation




Major Field of StudyExpected DegreeCareer Goal(s)

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 $ Amount
Tuition and Fees
Room and Board
Books and Supplies
Anticipated Personal Expenses (clothing, laundry, recreation, etc.)
Unusual or major expenses for which applicant is responsible
Total estimated financial need per year of college
Other Resources
DetailsEstimated $ Amount
Loan (s)
Family Financial Assistance
If family cannot assist financially, please explain:
Siblings/others dependent on the family:

Please select one: (required)
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)
You MUST include your GRADE TRANSCRIPTS, TWO signed letters of RECOMMENDATION, and any additional documents you'd like to include with your application here. (required)
Grade Transcripts and two signed letters of recommendation are required.
All statements in this application are correct to the best of my knowledge. (required)
Applicant Signature
Applicant NameDate of Application