SPO MEMORIAL ACADEMIC APPLICATION

Stig P. Orum Memorial Foundation
ACADEMIC APPLICATION
THE STIG P. ORUM MEMORIAL FOUNDATION MISSION

"To promote the betterment of young people and the safe-keeping of human lives; encourage education, leadership, and respect of humanity and the environment, in the spirit of Stig P. Orum."

This application must be postmarked by February 28th to be considered for the current year. Applications are preferred to be typed; if hand written, they must be legible in order for the application to be considered, and must be completed by the applicant themselves Applications are accepted only by mail; if an application is sent via email, it will not be considered for a scholarship.
GENERAL INFORMATION
NAME
DATE OF BIRTH

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
SOC. SEC. #
ADDRESS
CITY, STATE, ZIP CODE
PHONE
Format: (000) 000-0000.
EMAIL
example@example.com
Are you a U.S. citizen?
If no, of what country are you a citizen?
Where did you hear about the Stig P. Orum Memorial Foundation?
What is your connection to the Fox Valley or to the Stig P. Orum Memorial Foundation?

FUNDING
What is the full amount you are applying for?
Have you applied for funds from this foundation before?
If yes, when?
Are you funded in any other way?
If yes, please list sources and amounts contributed.

REFERENCES
Please provide at least three references. Without completing this portion of the application, you will not be considered for funding:

Address City, State, Zip

Rows	1	2	3
Name
Position
Relationship
Address City, State, Zip
Phone
Email

EDUCATION
School you are now attending (or last attended)
Expected Graduation Date
Rank in Class
Grade Point Average
SAT Scores (optional): English
Math
Reading
Science
Writing
SAT Composite (optional)
Date test was taken

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
School you plan to attend
Address
Field of study
Degree Anticipation
Career plans after school
Please list by academic year:
FRESHMAN
Extracurricular School Activities (athletics, organizations, clubs, plays, etc.)
Work Experience (list any significant work experience in the past two years)
Community/Campus Involvement (volunteer work, charity work, leadership roles, etc.)
SOPHOMORE
Extracurricular School Activities (athletics, organizations, clubs, plays, etc.)
Work Experience (list any significant work experience in the past two years)
Community/Campus Involvement (volunteer work, charity work, leadership roles, etc.)
JUNIOR
Extracurricular School Activities (athletics, organizations, clubs, plays, etc.)
Work Experience (list any significant work experience in the past two years)
Community/Campus Involvement (volunteer work, charity work, leadership roles, etc.)
SENIOR
Extracurricular School Activities (athletics, organizations, clubs, plays, etc.)
Work Experience (list any significant work experience in the past two years)
Community/Campus Involvement (volunteer work, charity work, leadership roles, etc.)
FAMILY INFORMAITON
Mother's Name
Mother's Employer (Name & Address)
Mother's Occupation / Title
Father's Name
Father's Employer (Name & Address)
Father's Occupation / Title
If either of your parents are veterans, please provide this information:
Branch of Service - Mother
Branch of Service - Father
Dates of Service - Mother

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Dates of Service - Father

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

Complete the section below for all dependents listed on your family's most recent income tax return:

Rows	Name (first and last)	Year Born
1
2
3
4
5
6

Please indicate the year, make and model of all cars driven by the family. (Do not include cars owned by people who are not claimed as dependents on the income tax return)

Rows	Year	Make	Model
Car 1
Car 2
Car 3
Car 4
Car 5

Please comment on the extent to which you need financial assistance. Please list all scholarships for which you have applied, and scholarships you have been awarded and the amounts.
Briefly (75 words) discuss your personal achievements and/or goals that you have reached the last four years which hold significant value to you and why.
ADDITIONAL INFORMATION
Please include any additional information which you feel may help demonstrate need or qualifications, for example, high school letters of reference, essays, SAT score, Common Core Reports, photographs, etc.
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HIGH SCHOOL TRANSCRIPT
To be eligible for the scholarship, we request a copy of your high school transcript. It may be attached or sent directly via mail to the Stig P. Orum Memorial Foundation no later than February 28.
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If selected for a scholarship grant, may we share your name, course of study and the college or university you are attending on our website to indicate you are a scholarship recipient? If yes, please sign here
Family Annual Income [Father and Mother/Guardian(s)]
Should be Empty:

ACADEMIC APPLICATION

GENERAL INFORMATION

FUNDING

REFERENCES

EDUCATION

Please list by academic year:

FRESHMAN

SOPHOMORE

JUNIOR

SENIOR

FAMILY INFORMAITON

ADDITIONAL INFORMATION

HIGH SCHOOL TRANSCRIPT