O.M.G.H.A.
Osseo / Maple Grove Hockey Association
Boys & Girls Youth Hockey Programs
The Terry Gallagher Award for Academics
ACADEMIC SCHOLARSHIP
APPLICATION
(Eligible applicants must have participated in the OMGHA Hockey programs for a minimum of 3 years and through
nd
her/his 2 year U14/Bantam OR until the point that she/he became a participant in her/his High School Hockey
program. All information shall be confidential. All non-selected application forms shall be destroyed 30 days after
scholarship is awarded. Successful applications will be kept on file, by the Scholarship Committee, for 1 year after
scholarship is awarded).
INSTRUCTIONS:
1) Provide all of the information asked for on this form.
2) Provide a photocopy of your most recent high school grade transcript, as well as a copy of Senior
year Trimester 1 & 2 grades.
3) Attach a photocopy of your letter of acceptance to an accredited College, University or Vocational
School
4) Attach letters of recommendation as follows:
a) One letter of recommendation from any one of your high school teachers or guidance counselor.
b) One letter of recommendation from a community leader (i.e. employer, church leader, coach,
scout leader, etc.)
c) Attached letters of recommendation must bear original signatures of the author, photo copied
signatures will not be accepted.
5) Complete and Attach the Leadership Resume document included with this application.
6) Attach a brief narrative describing how participation in an OMGHA program has influenced you.
STUDENT INFORMATION:
Name:
(Last)
(First)
(Middle)
Address:
(Street Address)
(City)
Applicant’s Home Number:
(Zip Code)
Applicant’s Cell Number ______________________
Applicant’s email address:_______________________________________________________________
Parent(s)/Guardian(s) Name:
(Last)
(First)
(Last)
(First)
High School Information:
High School from which you will graduate:
GPA (Minimum of 3.0 required)
_____________________________________________
What Post-Secondary school do you plan to attend?
Scholastic Night Participation:
How many years, while at the traveling hockey levels, were you recognized through the OMGHA
Scholastic Night Program?
OMGHA PARTICIPATION:
When was your most recent participation in OMGHA?
(Year/season)
For which team did you play?
Head Coach:
(name)
OMGHA Levels at which you participated: (Circle all that apply)
Mite
Supermite
Squirt/U10
PeeWee/U12
Bantam/U14
CERTIFICATION:
I certify that the information contained in this application is true and correct to the best of my knowledge.
I hereby authorize the OMGHA Scholarship Committee to contact the references provided. I hereby
authorize the High School listed above to release accumulated GPA information to the OMGHA
Scholarship Committee for consideration of this application only.
Student Signature
Date
Parent/Guardian Signature
Date
Mail to:
OMGHA - Terry Gallagher Award for Academics
Attn: Mimi Gallagher
7074 Terraceview Lane N
Maple Grove, MN 55311
Include all required supporting documents listed above and signatures. Applications
must be postmarked on or before April 25, 2015 to be eligible for consideration for 2015
Scholarship awards.