2021 OQHRA Scholarship Online Form

PLEASE COMPLETE ALL INFORMATION - TYPE OR PRINT

Applicant Name *

First

Middle

Last

Social Security Numbers *

Address *

Address Line 1

City

State

Zip Code

Phone *

Fax Number

Birthdate *

Sex

Email *

Marital Status *

Mother's Full Name *

First

Middle

Last

Father's Full Name *

First

Middle

Last

Custodial Parents Address *

Address Line 1

City

State

Zip Code

Are you a U.S. Citizen? *

Yes
No

If Not, from what country is your Citizenship?

Are you the recipient of any other scholarships or grants? *

Yes
No

If yes, name scholarships/grants and dollar amount(s):

Financial Information (this information will remain confidential):

Are you independent & living on your own? *

Yes
No

Do you provide for another dependent? *

Yes
No

Do you live at home with both parents? *

Yes
No

Do you live in a single-parent household? *

Yes
No

(if single parent see below)

Is your single parent

Mother
Father
Other

If other (provide details below)

If Other Single Parent Please Provide Details

Does any other party provide support to you?

Yes
No

Single Line Text

Are you claimed as a dependent on any Federal Income Tax Return? *

Yes
No

Do you receive a monthly check form the U.S. Government? *

Yes
No

Father's Information

Father's Place of Employment

Job Title

Annual Income

Work Phone

Mother's Information

Mother's Place of Employment

Job Title

Annual Income

Work Phone

Guardian Information

Guardian's Place of Employment

Job Title

Annual Income

Work Phone

Your Employment

If you are currently employed, please name employer

Your employer City and State

Your Employer's Phone

Academic Information

Intended Career Path *

Proposed Major *

Year of Graduation *

If not in college give date you will become a full-time college student

High School numerical average or cumulative GPA *

Are you enrolled in honors classes? *

Yes
No

Name of the college you plan to attend *

Are you currently attending college? *

Yes
No
Full Time (12+ hours)
Par Time

Class Rank (Freshman, Sophomore, etc.)

College GPA

College Name

City, State

Will you attend graduate school

Yes
No

If you will attend graduate school, give planned degree & area of study:

You may email no more than 2 other pages to further document the following information. Please be specific.

If we don't know which club or activity you are referring to, you will not receive credit for it.

Activities (other than school)

List activities you have undertaken that help define you as a person.

School Activities

Schools clubs & extracurricular activities.

National, State or Local Clubs/Activities

Related to your college major or field of study.

Other Activities (volunteer work, job seminars, etc.

Related to your college major field or study.

YOU MUST SUBMIT THE FOLLOWING BY EMAIL or US MAIL:

A) Certified High School Transcript, B) Certified College Transcript if applicable, C) Single-page, double-spaced, typewritten 495-525 word essay titled "Why I Want to Be Part of the Equine Industry and What I Hope to Accomplish," D) (optional) Signed copy of 2019 IRS Tax Returns for Applicant (if self supporting) or applicant's parent(s) is recommended and may be used as tie-breaker, E) Three (3) letters of reference, specifically one (1) from a high school/college teacher/school administrator and at least one (1) from a professional member of the equine industry; F) Current photo (head & shoulders) for publication purposes, and G) Typewritten letter of introduction.

Verification by Applicant (if you did not receive separate Scholarship Instructions, notify us immediately):

I hereby certify the statements recorded in this application are true and accurate, and that I meet all the requirements set forth in the OQHRA Scholarship Instructions and Rules. I understand if any statement presented in this application is untrue, I may be disqualified. If selected as a recipient, I understand that I may be listed on or in various equine-related web sites and/or publications. My signature verifies I agree with and accept the information printed above.

Name *

First

Middle

Last

Signature of Applicant *

Date *

Signature of Parent or Guardian

Date *