First Name:  Mid Init: 

Last Name:   

PSU ID: 

Email:

Home/Permanent Address 1 :

Home/Permanent Address 2:

City:   State:   Zip:

I will be enrolled: full-time (9+ credits) part-time(1-8 credits)

Current Employer:

Position Held:

Do you receive full or partial reimbursement from your employer: yes no

If partial reimbursement, what percentage?

Students interested in other financial aid opportunities should complete the 2008-2009 Free Application for Federal Student Aid (FAFSA). The FAFSA can be completed on-line at http://www.fafsa.ed.gov .  Students must be taking at least 5 graduate level credits per semester to be considered for the Federal Stafford Loan Program, Federal Perkins Loan Program, or Federal Work Study.  You should answer “yes” to the questions that ask if you are interested in loans or employment opportunities. For the maximum financial aid consideration, new MBA students should be offered admission to the MBA program and have the 2008-09 FASFA on file by March 1, 2008.

Questions regarding this scholarship opportunity or any other financial aid programs should be directed to Jane Brady at (814) 898-6456 or jub9@psu.edu.

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.