Scholarship Application The Orrstown Bank Foundation annually awards scholarships to eligible high school seniors attending secondary schools within the core communities that Orrstown Bank serves: Pennsylvania: • Cumberland, Franklin, Lancaster, or Perry Counties – All School Districts • Dauphin County: Central Dauphin School District Derry Township School District Lower Dauphin School District Harrisburg City School District Middletown Area School District Steelton-Highspire School District Susquehanna Township School District Maryland • Washington County – All School Districts General Instructions: Complete the application in its entirety. Submit the application, along with a personal letter of introduction, three letters of recommendation, and an official high school transcript with a school seal to: Scholarship Program, c/o Orrstown Bank, 77 E. King Street, Shippensburg PA 17257, or submit electronically to: [email protected]. Applications must be postmarked or received electronically no later than Friday, March 31, 2017. STUDENT INFORMATION (Please print clearly) Student's Full Name: Mr./Ms./Mrs. First Name M.I. Last Name Address: Street # and Name City State Zip Email Address: County of Residence: Date of Birth: Telephone number: Social Security #: Name of Parent or Guardian: www.orrstown.com 1 Complete Home Address (if different from application) SCHOOL INFORMATION (Please print clearly) High School Name: Date of High School Graduation: High School Address: Street City State Zip County List academic honors: (Include an additional page, if required) The Institution(s) to which I am applying for admission: Desired major/ area of interest: SIGNATURE AND DATE (required) By signing this document, I hereby submit my application to the Orrstown Bank Foundation for a scholarship. I have read the Orrstown Bank Foundation Scholarship Guidelines and understand the terms and conditions upon which a scholarship is granted. I certify that the above information is correct. The above information is furnished for use by the Orrstown Bank Foundation and the institution to which I am admitted. Student Signature Date COMMITTEE USE Date Received: www.orrstown.com 2 Scholarship Guidelines Scholarship Value Each scholarship is a one time, non-renewable $1,000.00 award. Number of Scholarships to be Awarded The number of Orrstown Bank Foundation Scholarships to be awarded each year will be determined by the Scholarship Committee. A representative of the Orrstown Bank Foundation and/or Orrstown Bank typically will attend either an awards assembly or graduation at the designated high school to present the Orrstown Bank Foundation Scholarship. Eligibility Criteria The Scholarship Committee will consider any application that is completed and submitted to the appropriate address by the published deadline provided the applicant: • Is enrolled as a full-time secondary student in good standing (as determined by his or her respective secondary school); • Will apply for admission to, be accepted to, and enroll at a post-secondary institution (e.g., university, college, community college, or technical school) for the 2017-2018 academic year as a full time student; and • Will graduate in 2017 from a public or private secondary school within the following counties and/or school districts: o Cumberland, Franklin, Lancaster, or Perry Counties in Pennsylvania o Dauphin County, Pennsylvania, limited to residents attending and graduated from schools within the following school districts: . Central Dauphin School District . Susquehanna Township School District . Harrisburg City School District . Steelton-Highspire School District . Middletown Area School District . Lower Dauphin School District . Derry Township School District o Washington County, Maryland Home- or cyber-school students who are legal residents of these counties or districts also are encouraged to apply. Factors considered by the Scholarship Committee The Scholarship Committee will review all materials submitted by an applicant. Due consideration will be given to factors that include, but are not necessarily limited to: academic achievement, test scores, service to the school and community, leadership, and financial need. No distinction or consideration shall be made with respect to race, color, religion, national origin, gender or sex, age, or marital status. www.orrstown.com 3 Additional Consideration Additional consideration may be given to students enrolled in the following institutions: Washington County • Barbara Ingram School for the Arts – Hagerstown, MD • Hancock Middle/High School – Hancock, MD • South Hagerstown High School – Hagerstown, MD • Washington County Technical High School – Hagerstown, MD Perry County • East Pennsboro Area SHS – Enola, PA • Newport High School – Newport, PA • Susquenita High School – Duncannon, PA Lancaster County • Octorara Area JSHS – Atglen, PA • McCaskey Campus – Lancaster, PA • Phoenix Academy – Lancaster, PA • Columbia High School – Columbia, PA Dauphin County • Price High School – Hummelstown, PA • Steelton-Highspire HS – Steelton, PA • Harrisburg High School – Harrisburg, PA • Harrisburg HS - SciTech Campus – Harrisburg, PA • Williams Valley JSHS – Williamstown/Tower City, PA Similar consideration also may be given to applicants attending schools not specifically named above, but which later are determined to serve student populations that may be considered “economically disadvantaged” as defined by the school districts and/or other appropriate governmental institutions. Conditions of the Scholarship Each scholarship is funded by the Orrstown Bank Foundation. The Foundation pays the value of an awarded scholarship directly to the scholarship recipient’s account at the designated post-secondary institution. The student shall not receive any direct cash benefit from the scholarship. It will be a condition of the award for the recipient to provide his or her social security number in order to facilitate payment to the institution. The recipient must have been accepted to, agreed to attend, and have enrolled in the institution on a full-time basis prior to the release of any funds. Once enrolled, the recipient must remain in good academic standing at the designated institution and satisfy the institution’s conduct requirements. When any student is selected as a recipient of an Orrstown Bank Foundation Scholarship, the student and/or his or her legal guardian agrees that the appropriate institution may provide to the Foundation www.orrstown.com 4 personal information concerning that recipient and whether or not the recipient has continued to remain enrolled at the institution in good standing during the 2017-2018 academic year, in accordance with the terms of the scholarship. The recipient’s acceptance of the scholarship shall serve as his or her agreement to the Foundation’s request for this confirmation from the institution. Scholarship funds for a student who withdraws or is removed from the school, or who becomes ineligible for the scholarship prior to the end of the school year must be refunded to the Orrstown Bank Foundation within 30 days following the date of withdrawal, removal or determination of ineligibility of the student. The scholarship reimbursement shall be pro-rated based on the amount of time remaining for the school term. Children or other legal dependents of employees, executives, or directors of Orrstown Bank Financial Services, Inc., Orrstown Bank, Orrstown Bank Foundation, or any affiliates or subsidiaries of any of these entities are not eligible to participate in this program. The Foundation is not responsible for lost, missing, misdirected, or late applications or supplemental information. All application information will be maintained by the Foundation in the strictest confidentiality. Scholarship Committee The Scholarship Committee will consist of a minimum of two (2) Representatives of Orrstown Bank, one (1) representative from Orrstown Bank’s Board of Directors, and five (5) representatives from various secondary and post-secondary institutions. The Scholarship Committee, at its discretion, may elect to conduct personal interviews with the finalists. News Releases The Scholarship Committee may elect to provide information on scholarship recipients to the media. Scholarship recipients grant the Orrstown Bank Foundation and any related entities permission to use their names and likenesses for promotional purposes as a condition of acceptance of the scholarship. www.orrstown.com 5 .