The Central Oklahoma Chapter of Hearing Loss Association of America will 
award two (2) $1000 scholarships to residents of Oklahoma who will be attending 
an institution of higher learning in Oklahoma. 

Application for HLAA Central Oklahoma Chapter’s Scholarship 

Name: __________________________________________ 

Parents name: _____________________________________ 

Address: _________________________________________ 

Phone: ___________________________________________ 

Email: ___________________________________________ 

Institution attending: _________________________________ 

Applications must be submitted in writing prior to April 2, 2018 and mailed to: 

HLAA Central Oklahoma Chapter 
PO Box 42801 
Oklahoma City, OK 73123 

or delivered in person Monday through Friday 10AM -3PM to: 

Hearing Helpers Room 
5100 N Brookline, Suite 100 
Oklahoma City, OK 73112 

Required Attachments: 
Essay 
Copy of audiogram or letter from an Audiologist or ENT 
Transcript(s) 
Copy of birth certificate or valid state issued ID 


The Central Oklahoma Chapter of Hearing Loss Association of America will 
award two (2) scholarships of $1000 each to residents of Oklahoma who will be 
attending an Oklahoma institution of higher learning the fall of 2018. 

The applicant must: 

• 
Present documentation of hearing loss; such as a copy of an 
audiogram or letter from a qualified professional (AuD or ENT) 
• 
Provide copy of birth certificate, valid state ID, etc. 
• 
Be resident of Oklahoma and submit residence address and 
phone number 
• 
Submit a transcript or other document showing GPA 
• 
Submit a copy of the Oklahoma institution of higher 
education's(*) acceptance letter 
• 
Agree to allow HLAA-COC use of name & photo 
• 
Submit completed application in writing by April 2, 2018 
• 
Submit an essay consisting of 1,000 – 3,000 words expressing 
your goals and telling your story of how hearing loss has 
affected your life 
• 
Agree to an interview of the Scholarship Selection Committee 
• 
One application per student 
• 
Scholarship recipients are selected by a Scholarship Selection 
Committee 
• 
Recipient will be notified in writing 
• 
Recipient must be willing to attend the August HLAA-COC 
meeting to receive the scholarship certificate 
• 
Funds may be used for tuition, fees and book expenses with 
scholarship funds paid directly to the institution 
(*) Higher education is defined as university, college, career 
training, or post-high school institution of learning