Leader of the Year Scholarship Information

Instructions

Please review this form in detail before entering information. Many of the fields require information that you must provide in order to submit this form. Your award package will not be complete until are required steps and documents are received.

First Name *

Middle Name or Initial

Last (Family) Name *

Gender Pronouns

ODK seeks to be sensitive to gender neutral/gender inclusive pronouns. Please include your preferred pronouns for publications (ie. he/him/his, she/her/hers, they/them/theirs, xe/xem/xyrs).

Email *

Provide a non-university email you are most likely to use for the next 3 years.

Mobile Phone *

Address *

Please provide an address to which we can send the framed certificate and other documents as necessary.

Apt, suite, etc.

Country

City

State

Zip code

Circle of Initiation *

Graduate/Professional School Information

In this section, please provide all the information about your graduate/professional school if you are starting in fall 2020 or spring 2021.

Name of Institution *

Name of Department or Program *

Anticipated Start Date *

Student Identification Number for Graduate/Professional School *

Verification of Enrollment *

Please upload a letter, official registration document, or a class schedule including a student ID number that verify you have been accepted and are enrolled in graduate/professional school. A letter of acceptance only is not acceptable.

Financial Aid Office Information *

Please provide the EXACT contact and address where your scholarship check should be mailed. Contact the institution's financial aid office to get the correct information. If O∆K does not receive the correct information, your scholarship may not be received by the school.

Scholarship Check Made Payable To: *

From the information provided by the Financial Aid Office, indicate to what office should the payment be made.

Acceptance Agreement *

I hereby acknowledge and affirm that the information provided in this form is true and accurate to the best of my knowledge.

I agree

Captcha *

reCAPTCHA is required.

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