Form C3

Name*
First Last
Middle Initial
Email*
Applicant's School*
How are you related to the OEA or OEA-Retired member?*
Name of OEA or OEA-Retired member*
Name of school where they are teaching or OPS schools where they taught (max of 3) and the number of years at each school. If they taught at more than 3 schools, list the three where they had the longest tenure and add “additional schools, ‘x’ number of years.”*
List the OEA or OEA-Retired activities/services in which the parent/grandparent has participated. This should include all OEA committees and offices held including AR, work done for endorsed candidates and service on joint OEA/OPS committees as a representative of the OEA.*
I certify that I have been an OEA or OEA-Retired member in good standing for the following number of years*
Signed

(Electronic signature of Parent or Grandparent)
APPLICANT must finish this statement: I have decided to pursue a career in elementary education because (100 words max):*
Thank You!
For current members, a minimum of three years OEA membership required for the above scholarships. By entering the confirmation code and submitting this form I certify that I (my parent or grandparent) have been an OEA member for more than three years.
Captcha

Thank You!