PLEASE PRINT CLEARLY
Player's Name:__________________________Grade:_______________
Sex: M F
Coach's Name (if known):____________________________________________
Parent / Guardian Name (Print):_______________________________________
Parent / Guardian Address:_________________City:___________Zip:________
Parent / Guardian Telephone Number:__________________________________
Parent / Guardian Signature:_________________________________________
Reason for Scholarship (please give us a brief overview of the reason):
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
Mail to:
OMGBA
Attn: President - Scholarship Request
P.O. Box 1764
Maple Grove, Minnesota 55311
