OTIS HIGH SCHOOL LOCAL SCHOLARSHIPS

Due Date: May 1st

Wayne and Thelma Simpson Memorial Scholarship

David Simpson Memorial Scholarship

Katie Sims

John Howlett

Otis Heritage Scholarship

Name:

Address:

Street or Box No.	City	State	Zip

Telephone Number:

High School: Otis School District R-3	Otis, Colorado

Name	Address

College you wish to attend:

Name	Location

Field of study or college major:

Cumulative Grade Point Average_______________________________________

Attach a list to include activities, organizations, offices, and honors that you have been in or received during your high school years.

Check one statement below which indicates your financial ability to

attend the institution of your choice:

will NOT be able to attend college without financial aid.

will probably attend college BUT will need some financial aid.

will be able to attend college WITHOUT financial aid.

Please complete the following items:

Father’s occupation:

Mother’s occupation:

Total number of family members living in the household and primarily supported by the reported income: ________________________________

Total number of family members attending college at least half-time during the next school year including applicant: _____________________

Please make a statement concerning your financial circumstances as they relate to attending the institution of your choice.

Are you applying for another scholarship? Yes ( ), No ( ) If you

checked YES, please give the name or names of other awards for which you are applying.

Please attach a list of activities, awards and community service completed or earned throughout your high school career. Also attach your resume to document any work history.

CERTIFICATION AND AUTHORIZATION

We have checked this form for omissions and errors. To the best of our knowledge, the information reported is complete and correct. We authorize its confidential use by the Scholarship Committee at the institution receiving it.

Date:	Signature of Parent/Guardian

Date:	Signature of Applicant