2010-2011 Academic Year Application
Application Deadline: July 15, 2010
Student Name:_____________________________________________________________
(Last) (First) (M.I.)
Student ID Number: _________________________________________________________
Home Address:
Street: __________________________________________________________________
City ________________________________State: _______________ Zip:_____________
Home Telephone Number: ___________________________________________________
School Telephone Number: __________________________________________________
E-mail Address: ____________________________________________________________
PASSHE University Attending: _______________________________________________
Area of Study______________________________________________________________
Number of Credits Completed: _______________________________________________
Current Grade-Point Average: ________________________________________________
(Include Official Academic Transcript)
I declare that the information provided herein is true and correct to the best of my
knowledge. I also give permission to release my name and photograph to the
Scholarship Committee and to the PASSHE Foundation for promotional purposes.
____________________________________ ___________________________
Signature of Scholarship Applicant Date
Please include the following with your completed application:
- Two letters of reference.
- Your five-hundred to eight-hundred word essay on “We make a living by what we do, but we make a life by what we give.” —Winston Churchill
- Your official academic transcript.
The complete application package should be submitted by July 15, 2010, to:
Eileen Showers
Director of Scholarship Programs
PASSHE Foundation
2986 North Second Street
Harrisburg, PA 17110
