2008-2009 Erie Insurance Group Leadership Scholarship Application

FOR STUDENTS ENROLLED OR PLANNING TO ENROLL IN THE MANAGEMENT INFORMATION SYSTEMS OR MATHEMATICS PROGRAM AT PENN STATE ERIE, THE BEHREND COLLEGE

Consideration for this scholarship shall be given to full-time undergraduate students enrolled or planning to enroll in the Management Information Systems or Mathematics Program at Penn State Erie, The Behrend College.  Preference shall be given to children of employees of Erie Insurance Group regardless of county of residence.

DO NOT COMPLETE THIS APPLICATION UNLESS YOU HAVE A PARENT EMPLOYED BY ERIE INSURANCE GROUP.

First Name:  Mid Init: 

Last Name:   

PSU ID: 

Email:

Home/Permanent Address 1 :

Home/Permanent Address 2:

City:   State:   Zip:

Name of Family Member Employed by Erie Insurance Group:

Department:

Relationship to Student:

RELEASE STATEMENT:

In accordance with the Family Rights and Privacy Act of 1974, I hereby authorize the Financial Aid Office at Penn State Behrend to release the information contained on this application, in addition to grade point average, to representatives of the organization sponsoring the scholarship and members of the scholarship committee for use in evaluating scholarship applicants.

I understand that scholarship awards may be adjusted or revoked due to unsatisfactory academic progress, change in enrollment status, ceased enrollment at Penn State Behrend, or otherwise failing to meet the guidelines of the awarded scholarship.

SUBMIT THIS APPLICATION BY FEBRUARY 1, 2008.

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Updated September 27, 2007
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