SCHOLARSHIPAPPLICATION
Masters in Energy Legal Studies
Oklahoma City University
PERSONAL INFORMATION:
(Please list your legal name)
Last Name------------
Birth Date (MMIDDIYY)__..c./ _..c./ _
First Name _
SSN # _
MI __
)
Street Address-------------
Preferred Phone (home/work/cell)(
(circle one) --------
City/State/Zip _
Email _
EDUCATIONAL AND PROFESSIONAL TRAINING
Please list, in order of attendance, all college level educational institutions attended.
Name of Institution Oty, State From Date To Date Degree/Certification
CURRENT AND PAST EMPLQYMENT (In Chronological Order)
Dates of Emplovrnent Companv Name, Otv, State Position
APPLICATION QUESTIONS
1. Attach a brief statement explaining your need for financial assistance.
2. Attach a 500 word essay that answers the following question:
How tIn you plan to use this degree tofurther your career in Oklahoma's oil and natural gas industry?
SCHOLARSHIP GUIDELINES
• Applicant must be a current resident of the state of Oklahoma.
• Applicant must be enrolled in Oklahoma City University's Masters in Energy Legal Studies.
• Applicant should have sufficient need for financial assistance.
SUBMIT APPLICATION/QUESTIONS
OERB
3555 NW 58th St, Suite 430
Oklahoma City, OK 73112
scholarships@oerb.com
Phone: 800-664-1301, ext 216
Fax: 405-942-3435
vl.l revised 12/18/11
Applicant's Signature Date
