ODSA Scholarship Application - Can Learn Smart

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Below is the application for the Tech Access and Inclusion Fund scholarship.

Upon completion of this form you’ll be emailed a copy for your records and to ensure the information is correct.

If you have any questions please Contact Us and we’ll be happy to help.

We look forward to meeting you and helping you do more with data in your career path!

Scholarship Application

Classes of Interest *

Data Visualization Certificate

Business Intelligence Certificate

Data Engineer Certificate

Machine Learning Certificate

Fundamentals of Data Science Certificate

*Select All the Classes You'd like to enroll in.

**Contact Information**

Your Name *

<b>**Contact Information**</b><br><br>Your Name

First

Last

Address *

City *

State *

ZIP *

Email *

*Preferred Email

Phone 1 *

*Preferred Contact Phone Number

Phone 2 *

*Backup Phone Number - Or - Verify Primary Phone Number

Month of Birth *

Day of Birth *

Year of Birth *

LinkedIn Profile

**Demographic Data**

Note: Our Mission at the ODSASF is to expand and diversify the data science community. Our goal is to award a
significant portion of scholarships (at least 75%) to low-income individuals, women, and/or racial and ethnic minorities
so the data science field better represents the communities it serves.

Being none of these is not a precluding factor for an award.

*Any Demographic Data provided is available only to selection committee. Any reporting
will be done at the macro level.

How do you Identify?

Male

Female

Genderqueer/Non-Binary

I prefer not to answer

Ethnicity

Caucasian

Hispanic

Black or African American

American Indian or Alaska Native

Asian

Native Hawaiian or Other Pacific Islander

An Ethnicity not listed above

Multiracial

Military Status

Active Duty

Reserves

Veteran

No Military Service

Income Range

Less than $20,000

$20,000 to $34,999

$35,000 to $49,999

$50,000 to $74,999

$75,000 to $99,999

Over $100,000

Education Level

What is your highest level of education? We take students at all levels, but it helps us develop new programs for future students.

Name of School/Program

Not required, but helps us with future marketing and potential partnerships.

**Scholarship Questions**

How did you hear about our scholarship? *

Are you currently working with anyone at: *

Contemporary Analysis

Omaha Data Science Academy

Nebraska Tech Collaborative

AIM

Code Black

Western Iowa Community Foundation

None

Have you applied to WIOA? *

Yes

Are you willing to match at least some portion of the scholarship for your education? *

Yes

It is simply not an option at this time

If yes, how much?

Tell the selection board how a certification from the ODSA is going to improve your life. *

**Student Agreement and Signature** *

The student, by signing this Agreement, agrees that, to the best of their ability the information provided on this sheet to be true.

Date of Signature *

Digital Signature Acceptance *

I Understand and Agree

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If you are human, leave this field blank.

PROUDLY SUPPORTING OUR MILITARY MEMBERS

Enroll Now!

OMAHA DATA SCIENCE ACADEMY

2112 N.30th Street
Omaha NE, 68111