Scholarship Request Form

OMG Scholarship/ Grant Request
Student's Name *

First Name Last Name
Student's School *
Students Grade Point Average
Which OMG Camp would you like to attend?: *
Interested in playing on TEAM OMG Basketball Team?: *
Parent/Guardian Name: *

First Name Last Name
E-mail Address *
Students's Age *
Grade: *
Phone Number *

Area Code Phone Number

Mailing Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Household Annual Income: *
Reason applying for grant: *
Should be Empty: