Date of Birth:
 

Student's Full Name:
 

Student's Permanent Mailing Address:
 

Student's City, State, Zip:
 

Student's Home Phone Number (ex. XXX-XXX-XXXX):
 

E-mail Address:

Year of High School Graduation (ex. 2009):
 

Name of High School:
 

In lieu of graduation from high school or receipt of a high school diploma, I have taken the GED test and received a certificate of high school equivalency. Yes   No 
*Note: You must submit a copy of your GED test scores with this application. 

Expected year in college for 2009-2010 (check one):
Freshman  Sophomore  Junior
Senior/Continuing Undergraduate
Post Graduate/Masters

College Major for 2009-2010:

Name of College:


College Financial Aid Office Address:


College Financial Aid Office Phone:

Parent or Guardian Name:

Parent's Address:

Parent's City, State, Zip Code:


I hereby authorize the Financial Aid Office of the above mentioned college (E12) to verify information in Section I and to release all my registration, educational costs and financial aid information to the Pennsylvania State Showmen's Association Scholarship Committee, 
P.O. Box 5, New Tripoli, PA 18066. 

Signature (Please type full name):

Date:

Section II: Essay Questions
INSTRUCTIONS: The following should be answered in essay form so we can get to know more about you as a person. Please take your time, remembering your answers will be considered in making our decision. 

1. What is your affiliation with the outdoor amusement industry and what has it meant to you?
 

2. Write a short autobiographical statement. This statement should include reasons for enrollment in your chosen field of study; accomplishments, awards, community activities, or anything you feel would be helpful to us in making our decision. Feel free to blow your own horn.
 

3. How have you assumed personal responsibility for financing your education (include grants/scholarships received and employment)?
 

4. Comments: (Optional - May be used to tell us anything you feel we should know, but failed to ask.)