APPLICATION FOR SCHOLARSHIP I, ________________________, understand that I have applied for a scholarship at Carson Oil Co., Inc.

and affirm my wish to be considered. Permission is hereby granted and given to officials of my institutions to release transcripts of my academic record and other requested information for consideration in the Carson Oil Co., Inc. scholarship program. I understand that this application will be available only to qualified people who need to see it in the course of their duties. I waive the right to access letters of recommendation on my behalf. This application, including the essay, is my own work or formally cited from other sources. I affirm that the information contained herein is true and accurate to the best of my knowledge and belief. Return this application, a current transcript and any other material you would like to be considered by no later than April 1st for the upcoming academic year to: Carson Education Trust c/o Lance Woodbury Carson Oil Co., Inc. 3125 NW 35th Ave. Portland, OR 97296

BIOGRAPHICAL QUESTIONNAIRE
A. You, the Applicant Legal name in full:
Last____________________________First____________________Middle_________________ Permanent Residence: Street number and name: _________________________________________________________ City____________________________State________________Zip Code___________________ Telephone________________________E-mail:_______________________________________ Facebook site:_____________________ Birthdate:_________________________________ / No If no, what is your citizenship?____________

Are you a U.S. Citizen?

Yes

What is your current academic grade status?___________________________________ Have you received a high school diploma? Yes / No

What academic grade are you applying for scholarship?__________________________

Will this be a full-time study program?

Yes

No Yes / No

Will you be working during this study program?

If yes, where?_____________________________________________________ Name of Parent(s) that works for Carson Oil Co., Inc.:___________________________ How many hours can you take and are you taking? ___________ How much will the tuition be? _____________

_______________________________________ Yes / No

Will you be living on campus or in campus provided housing?

How much is room and board? ______________________________________ What other expenses do you anticipate? _____________________________________.

B. Your Aspirations i) In one or two sentences, please describe your career goals:

ii) What are your professional aspirations and what needs or problems do you hope to address?

C. Your Schooling

1.

What is the name of your current school?_________________________________ Contact address:__________________________________________________ Contact phone:___________________________________________________

If an undergraduate, what is your undergraduate major?_________________________ What is your cumulative GPA for the current school program:______________________ What school(s) are you applying for or returning to?_____________________________ Dates attended:_____________________________________________________ 2. List any awards, honors, scholarships you have received in the last 4 years.

YOUR ACCOMPLISHMENTS

1. List any public service and community activities.

2. Describe any non-course related research experience, job experience or other experience you want considered. Please indicate how this experience affected you.

3. Describe any leadership experience in which you made a difference.

4. Describe any specific activity that has been important in clarifying or strengthening your character.

5. Is there any additional information about you that you would like to be considered?

SIGNATURE BLOCK

Applicant Signature__________________________________Date_____________