Paul C. Roche, Sr. Memorial Scholarship Application

FOR STUDENTS ENROLLED OR PLANNING TO ENROLL AT PENN STATE ERIE, THE BEHREND COLLEGE

Consideration for this scholarship shall be given to all undergraduate students enrolled or planning to enroll at Penn State Erie, The Behrend College, who are in good academic standing or who manifest promise of academic success.  Priority will be given first to students who are children of former employees of Erie Plastics, Inc. Among these applicants, first preference will be given to students majoring in Plastics Engineering Technology; second preference to students majoring in a major within the Sam and Irene Black School of Business or School of Engineering; and third preference to students in any other Behrend major.  If there are no applicants who are children of former Erie Plastics, Inc. employees, then preference will go to students majoring in Plastics Engineering Technology.

DO NOT COMPLETE THIS APPLICATION UNLESS YOU HAVE A PARENT WHO WORKED AT ERIE PLASTICS, INC.


First Name:  Mid Init: 

Last Name:   

Email:

Home/Permanent Address 1 :

Home/Permanent Address 2:

City:   State:   Zip:

Current or intended major:

Name of family member employed by Erie Plastics, Inc or one of its successor companies: 

Relationship to Student:

RELEASE STATEMENT:

In accordance with the Family Educational Rights and Privacy Act of 1974 (FERPA), I hereby authorize the Pennsylvania State University to release personally identifiable information from my education records, including but not limited to major, activities, grade point average, financial need information, and other information to donors who will be considering me for the scholarship for which I have applied. This release of information is necessary for the selection process for the award. I also authorize the University to periodically release personally identifiable information to the scholarship donor for the purpose of updating the donor on my progress at the University. I also authorize the release of personally identifiable information to the public through a press release; newsletter announcement; or a banquet or program booklet. I understand that (1) I have the right not to consent to the release of my education records under FERPA; (2) I have the right to receive a copy of such records upon request; (3) and that this consent shall remain in effect until revoked by me, in writing, and delivered to the Penn State Behrend Financial Aid Office.

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.

PRIORITY APPLICATION DEADLINE IS FEBRUARY 1

APPLICATIONS ARE ACCEPTED ALL YEAR


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Updated October 20, 2009
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