SCHOLARSHIP

Greater Erie Economic Development Corporation

Scholarship Application
Please check the following to see if you qualify. Must check all to apply:

Resident of Erie CountyBIPOCAge 18-25
APPLICANT GENERAL INFORMATION:
Last
First
Middle
Street
Apt. #
City
State
Zip
Date of Birth

MonthDayYear
Date
Email Address
example@example.com
Home Phone Number
Please enter a valid phone number.
Alternate Phone Number
Please enter a valid phone number.
FAMILY INFORMATION
Parent/Guardian
Parent/Guardian
Alternate Phone Number/Contact Name
Financial Data

Parent(s) or Guardian (s) Place of Employment (X) if unemployed:
Mother
Employer
Father
Employer
Applicant
Employer
PLEASE CHECK SOURCES OF INCOME
( ) Public Assistance
( ) Social Security
( ) Salaries
( ) Other Income
Annual Family Income
Amount Requested
APPLICANT ACADEMIC STATUS AND HIGH SCHOOL INFORMATION

Applicant: To the best of your knowledge, please record your information in the boxes below.
High School
Address
City
State
Zip
Intended Major
Name of College or University You Have Applied To
COMMUNITY INVOLVEMENT
School/Extracurricular activities: What activities have you been involved in in the last four years (school clubs, student government, varsity or club sports, theater arts, Scouting, 4 H etc.)?
Community/Volunteer Service. What agencies or organizations have you participated without pay during the last three years (religious groups, hospital volunteer, cultural activities, outreach programs, etc.)?
Work Experience: List the last three jobs you have held the longest (food server, babysitting, lawn mowing, office work, etc).
1.
2.
3.
CERTIFICATION and AUTHORIZATION
(HOLD)
AUTHORIZATION FOR RELEASE OF RECORDS
To comply with the provisions of the Family Educational Rights and Privacy Act of 1974, permission is hereby given to applicant’s school officials to release the applicant’s secondary school record and other requested information in consideration for this scholarship.
Applicant signature (required)

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Date

MonthDayYear
Date
PLEASE CHECK TO MAKE SURE THE FOLLOWING DOCUMENTS ARE INCLUDED:

1.     FAFSA completion letter/email (indicating you have submitted your FASFA application).

2.     Information on any other scholarships you have received.

3.     Tuition statement from your University.
FASFA COMPLETION LETTER/EMAIL

Cancelof
INFORMATION ON OTHER SCHOLARSHIPS RECEIVED

Cancelof
TUITION STATEMENT FROM YOUR UNIVERSITY

Cancelof
Please note: Scholarship awards are for the current year only. Scholarship renewal is not guaranteed. Applicants must re-apply on a yearly basis to be reconsidered.
Should be Empty:

Greater Erie Economic Development Corporation

APPLICANT GENERAL INFORMATION:

FAMILY INFORMATION

Financial Data

PLEASE CHECK SOURCES OF INCOME

APPLICANT ACADEMIC STATUS AND HIGH SCHOOL INFORMATION

COMMUNITY INVOLVEMENT

Work Experience: List the last three jobs you have held the longest (food server, babysitting, lawn mowing, office work, etc).

CERTIFICATION and AUTHORIZATION

AUTHORIZATION FOR RELEASE OF RECORDS