Dear Odd Fellows and Rebekahs,

Remember the admonition to “. . . educate the orphan . . . ”

The “Triffle P. and Annie G. Ivancovich Scholarship Fund” is again open for applications and nominations. This fund is available to orphans and former foster children and can provide up to $10,000 per year in college support for entering Freshmen. There are strict grade point average requirements and it is competitive. The deadline for submission of nomination forms (only Odd Fellows and Rebekahs can nominate) and application forms is March 1, 2017.

The application and nomination forms can be accessed and downloaded at www.davislodge.org. On the home page move your cursor to the top the page over the words LODGE PROGRAMS and click on “Orphan Scholarship Fund.”

Thank you.

F – L – T

Dave Rosenberg, PGM
Chairman
Davis Odd Fellows Charities, Inc.

Davis Odd Fellows Charities, Inc.
Application Form

Odd Fellows and Rebekahs in good standing may nominate eligible orphans and foster youth or emancipated foster youth for educational scholarships provided by Davis Odd Fellows Charities, Inc. All decisions by Davis Odd Fellows Charities, Inc. are made in the sole discretion of the corporation. To be eligible for consideration, nominees must be orphans or foster youth, must be at least 18 years of age at the time they enter college/university, must be U.S. citizens, must have attained at least a B+ average upon high school graduation, and must be accepted to an accredited college/university or a legitimate junior college and entering as a freshman. Educational scholarships, if approved, will be at least $5,000 and up to $10,000 for the freshman year, based on merit and need. Students may re-apply for a subsequent year, up to four years in total, based on merit, need, and the ability to maintain a GPA of at least 3.33. Application must be received by Davis Odd Fellows Charities, Inc., not later than March 1, 2017. When complete, mail to: Davis Odd Fellows Charities, Inc. Attn: Dave Rosenberg, 415 Second Street, Davis CA 95616.

Please Print

Name of Applicant _____________________________________________________

Date of Birth ______________ Age _______ Are you a US citizen? _____________

E-mail Address ________________________________________________________

Mailing Address: _______________________________________________________

Are you an orphan or foster youth? _______ At what age did this occur? ____________

Name of High School ___________________________ Year of Graduation __________

Address of High School __________________________________________________

GPA on Graduation _________ Have you been accepted to college/university? ________

Name of college/university _______________________________________________

Accredited? ____ Date when school starts ________ Expected graduation year ______

Your major? ________________ Amount of requested scholarship ________________

Please answer the three questions on the next page as part of this application. Also attach a transcript showing your grades achieved during the previous school year.

I certify the information above and on the next page is true and correct.

Dated: _____________________________
Signature of Applicant

What are the circumstances of your becoming an orphan or foster youth?

Why do you need this scholarship?

What do you hope to accomplish in your life upon graduation?

Davis Odd Fellows Charities, Inc.
Nomination Form

Odd Fellows and Rebekahs in good standing may nominate eligible orphans and foster youth or emancipated foster youth for educational scholarships provided by Davis Odd Fellows Charities, Inc. All decisions by Davis Odd Fellows Charities, Inc. are made in the sole discretion of the corporation. To be eligible for consideration, nominees must be orphans or foster youth, must be at least 18 years of age at the time they enter college/university, must be U.S. citizens, must have attained at least a B+ average upon high school graduation, and must be accepted to an accredited college/university or a legitimate junior college and entering as a freshman. Educational scholarships, if approved, will be at least $5,000 and up to $10,000 for the freshman year, based on merit and need. Students may re-apply for a subsequent year, up to four years in total, based on merit, need, and the ability to maintain a GPA of at least 3.33. Nomination form must be received by Davis Odd Fellows Charities, Inc., not later than March 1, 2017. When complete, mail to: Davis Odd Fellows Charities, Inc. Attn: Dave Rosenberg, 415 Second Street, Davis CA 95616.

Please Print

Name of Odd Fellow/Rebekah Nominator______________________________________

Lodge Number ____________ Lodge Name ____________ Lodge City _____________

Address of Lodge ______________________________________________________

Nominator’s Phone Number _______________________________________________

Nominator’s E-mail Address _______________________________________________

Nominator’s Mailing Address _______________________________________________

Name of Applicant you are nominating ________________________________________

Address of Applicant ____________________________________________________

Have you discussed this nomination with Applicant? _____________________________

Does the Applicant wish to be nominated? ____________________________________

Why are you nominating this Applicant? ______________________________________

____________________________________________________________________

___________________________________________________________________.

I certify the information above is true and correct.

Dated: _____________________________
Signature of Nominator