Kim Barbara and Nicholas C. Scott Scholarship Application

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

Consideration for this scholarship shall be given to full-time students who are enrolled or planning to enroll at Penn State Erie, The Behrend College.   Financial need may be a consideration, but it is not a requirement, for eligibility of the scholarship.   First preference shall be given to students who are employees or children of employees of Scott Enterprises, Inc.

(Key employees and directors of Scott Enterprises, Inc. or their children shall be ineligible for this scholarship.  For purposes of interpreting this provision, the University shall be governed by the definition of key employee as provided in Section 416 of the Internal Revenue code, as amended from time to time.)

DO NOT COMPLETE THIS FORM UNLESS YOU, YOUR PARENT, OR YOUR GRANDPARENT ARE EMPLOYED BY SCOTT ENTERPRISES, INC.


First Name: Mid Init: Last Name:   

Email:

Home/Permanent Address 1:

Home/Permanent Address 2:

City:   State:   Zip:
 

Name of Family Member Employed by Scott Enterprises, Inc.:

First Name: Mid Init:  Last Name:   

What property through Scott Enterprises, Inc. does the family member work for:


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 ACCEPTED ALL YEAR


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