Please complete and submit this form to apply for the Out-of-State Opportunity Scholarship. All fields are required to apply for this program.
Present Address
City
State
Postal Code
Home Telephone
Permanent Address [If under the age of 24]
Alternate Phone
Do you hold permanent or temporary resident immigration status? Yes No
Do you hold Refugee or Political Asylum Status? Yes No
[If you answered yes to either of the above, you must send a copy of both sides of Resident alien Card or Form 1-94 or other documentation via fax: 503-725-5595 Attn: Jackee McDonald, OOS Scholarship Coordinator. An alien possessing a non immigrant or temporary (e.g., B,C,D,F,J, or M) visa cannot be classified as a resident.] Length of residency in your present state:
From [mm/dd/yy]: To [mm/dd/yy]: State:
If you experience technical difficulty, please contact OOS Opportunity staff at 503-725-5531 or oos@pdx.edu.