APPLICATION FOR RACHEL OLSON CHARITABLE …

1 APPLICATION FOR RACHEL OLSON CHARITABLE trust DESIGNATION AS A LLOYD AND RACHEL OLSON MEMORIAL SCHOLARSHIP * this APPLICATION must be typed *TO THE LLOYD AND RACHEL OLSON SCHOLARSHIP COMMITTEE: I do hereby make APPLICATION for a scholarship as above designated. In connection therewith I hereby agree that I have read the RACHEL OLSON CHARITABLE trust - Lloyd and RACHEL OLSON Rules and Procedures which are incorporated into this APPLICATION by reference and I agree with the provisions thereof, particularly with those provisions requiring me to refund to the trust any monies advanced to or on my behalf under certain terms as therein expressed. As said APPLICATION , I furnish herewith the following information: _____Address_____Phone # period of time that I have attended school in the Maple Valley-Anthon OtoCommunity School District is Security (s) or Guardian(s):Name(s) school from which I have or will receive my high school degree?

2 _____ Year Graduated and address of advanced educational institution I plan to attend am applying for the scholarship based on the following : (Check One)_____ Financial Need (see Exhibit A attached hereto); _____ Exceptional Scholarship (see Exhibit B attached hereto); _____ Both Financial Need and Exceptional Scholarship (see Exhibits A and B attached hereto.) as Exhibit C is a brief statement as to why I believe that I qualify for and deservea understand that this APPLICATION will not be considered for scholarship of any greater periodthan one year, but that I may reapply for successive scholarships of additional periods of oneyear as set out in the RACHEL OLSON CHARITABLE trust - Lloyd and RACHEL OLSON MemorialRules and am not related to any member of Lloyd and RACHEL OLSON Scholarship Committee or to any spouse of any member of said committee in that I am neither the child, grandchild, nephewnor niece, or sibling of any member or spouse of the hereby authorize the committee to verify any of the information I have disclosed Signature of Applicant _____ Date RETURN this APPLICATION BY OR POSTMARKED BY APRIL 1 st, 2019 TO BE CONSIDERED FOR THE SCHOLARSHIP TO: ANGIE SCHRUNK SECURITY NATIONAL BANK of Mapleton P.

3 O. BOX 178 313 North 4th Street MAPLETON, IA 51034 LLOYD AND RACHEL OLSON SCHOLARSHIP COMMITTEE: Angie Schrunk Pastor, Lutheran Church of Soldier, Iowa Thomas R. Mohrhauser Steven Oberg Tamara Flanigan RACHEL OLSON CHARITABLE trust Thomas R. Mohrhauser, Trustee 314 Main Street P. O. Box 227 Mapleton, IA 51034 (712) 882-1468 REMINDERS: on this APPLICATION must be typed or your APPLICATION will not be APPLICATION must be signed by the Applicant or it will not be Applicant must be applying based on Need or Scholarship or both Need and Scholarship, therefore check one item in #7 or your APPLICATION will not be applying based on financial need, the items in Exhibit A must be included or you willnot be you are applying based on exceptional scholarship, the items in Exhibit B must beincluded or you will not be you are applying based on both financial need and exceptional scholarship, the items inExhibit A and Exhibit B must be included or you will not be considered for A If you are applying for a scholarship based on financial need, please attach a completed copy of the FAFSA (Free APPLICATION for Student Aid) showing 2017 income and current assets.

4 How do you plan on financing your education? _____ Exhibit B If you are applying for a scholarship based on exceptional scholarship, please attach a transcript of classes and your grade point average while in high school, and if applicable during post high school attendance. You must also provide a copy of your college entrance exam scores (EX: ACT, SAT). Exhibit C I bel ieve I qualify for and deserve this scholarship because: (Include extracurricular activities you are involved in, civic, membership organizations, community.) _____