Editing previous response:

Please fix the highlighted areas below before submitting.

OMI College Bound Scholarship Fund Disbursement Request

Please complete the form below. Required fields marked with an asterisk *

Below are the steps to be taken to tap into your earned OMI Scholarship Funds. Please keep in mind that reimbursements are ONLY allocated for confirmed educational purchases only (receipts MUST BE provided; no exceptions). Money is NOT reimbursed in one lump sum. Please send documents spearately. Once you have gathered all required documentation, send complete packet:

Online Process

STEP 1: Complete the OMI College Bound Scholarship Fund Disbursement Request Form

STEP 2: Complete the Reimbursement Request Form and Download a Copy

STEP 3: Gather Supporting Documents

Reciepts
Copy of student ID card and class schedule

STEP 4: Upload the completed Reimbursement Request Form and Supporting Documents

STEP 5: Confirm that you are not a robot and Submit

You may also Print these documents and Send them to Dr. Spencer-Brown

Once these documents are uploaded/sent and received by Dr. Spencer-Brown, they will be processed and confirmed for thoroughness. If any information is missing, Dr. Spencer-Brown will make contact with the requestor to obtain correct information. Once paperwork is processed it will be sent over to the OMI Business Office for fiscal processing. Please keep in mind that the reimbursement process can take up to three weeks to be finalized. Thank you for your patience.

If you have any questions or need assistance with the process , please feel free to send an email to Dr. Spencer-Brown at [email protected].

OMI College Bound Scholarship Fund Disbursement Request Form

Contact Information

First Name

Answer required for "First Name"

Middle Name

Answer required for "Middle Name"

Last Name

Answer required for "Last Name"

Address

Street Address

Answer required for "Street Address"

City

Answer required for "City"

Zip/Postal

Answer required for "Zip/Postal"

Answer required for "Email"

Best Contact Phone Number

Number Required

OMI Graduation Date

Graduation date can not be more than 4 years prior to this request.

Answer required for "OMI Graduation Date"

Beginning date you started at OMI

Answer required for "Beginning date you started at OMI"

Request Date

Answer required for "Request Date"

Request Amount (max $1400)

Answer required for "Request Amount (max $1400)"

Disbursement Information

Name of accredited higher education institution, community college, trade school, or vocational college.

Answer required for "Name of accredited higher education institution, community college, trade school, or vocational college."

Street Address

Answer required for "Street Address"

City

Answer required for "City"

Zip/Postal

Answer required for "Zip/Postal"

Bursar's Office phone number

Number Required

Student account number at institution

Answer required for "Student account number at institution"

How will these funds be used?

Answer required for "How will these funds be used?"

In addition to completing the above section, CURRENT HIGH SCHOOL STUDENTS ELIGIBLE FOR GRADUATION who are requesting money between March 1 - may 31 must complete the section below.

Please select the reason why you need funding:

Note: You are required to submit a receipt after using funds for the above purposes. Such receipts may be in your Email's inbox. Please upload the receipts below, send or deliver receipts to the OMI Counseling Department.

Answer required for "Please select the reason why you need funding:"

Assessment Tests

Intent to Register Deposit

Housing Deposit

Other:

Electronic Signature Agreement

You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By selecting "I Accept" you consent to be legally bound by this Agreement's terms and conditions.

Answer required for "You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By selecting \"I Accept\" you consent to be legally bound by this Agreement's terms and conditions."

I Agree

Electronic Signature (Print Fullname)

Answer required for "Electronic Signature (Print Fullname)"

Today's Date

Answer required for "Today's Date"

Reimbursment Request Form

Upload Completed Reimbursement Request and Supporting Documents

Answer required for "Upload Completed Reimbursement Request and Supporting Documents"

Choose a file or drag it here.

Confirmation Email

Answer required for "Confirmation Email"