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Oregon Peace Officers Association ACADEMIC SCHOLARSHIP APPLICATION Personal Information Last Name: ____________________________First: ____________________Middle: _______________ Home Address: _______________________________________________________________________ City, State, Zip Code: __________________________________________________________________ County__________________________________ Telephone Number: _______________________________Date of Birth: _________________________ OPOA Member Name: ____________________________________Relationship: __________________ Address: ____________________________________________________________________________ City, State, Zip Code: __________________________________________________________________ Academic Record High School: ___________________________________Location: _________________________ High School Cumulative Grade Average: _____________________(A=4 B=3 C=2 D=1) Ranking in Graduating Class: ___________________Number in Graduating Class: __________________ College and Location (If not currently enrolled, which college you plan to attend):___________________ ____________________________________________________________________________________ College GPA (if applicable):___________________________ Major: ___________________________________________ Applicant's Signature: _________________________________________Date: _____________________
Attach Essay For Scholarship Committee Use Only
Date Received: ____________________Reviewed: _____________________Recommended: __________________ OPOA Executive Board Approval: Y N Scholarship Awarded: Y N
OPOA President's Signature: ______________________________________________________________________ |