List Academic Awards and Honors: (Attach additional pages if necessary.)
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List Organizations and Leadership Positions: (Attach additional pages if necessary.)
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List Community Service Activities: (Attach additional pages if necessary.)
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Family Income____________(Adjusted gross income may not exceed $50,000.)
Parents, custodial parents, or legal guardian must submit a copy of the official
federal income tax return form filed for 2013 or 2014. This information will be kept
confidential and will be destroyed upon verification by the program administrator.
If a tax return was not required to be filed, please provide alternative
documentation of income.
Student Signature_____________________________
Date____________________
Application deadline is March 27, 2015. Mail completed application, high school transcript
and 2013 or 2014 tax return to:
The Frances Koop Parsons/AT&T Pioneers Memorial Scholarship
Oklahoma State Regents for Higher Education
Post Office Box 108850
Oklahoma City, OK 73101
Phone 800.858.1840 or 225.9131 in the Oklahoma City area