PSATS Scholarship Application Form

Name *

Address *

Address Line 1

Address Line 2

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Layout

Township of Residence *

Phone *

County of Residence *

Email *

High School *

High School Address

Address Line 1

Address Line 2

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

GPA *

Name of Planned College/University/Program *

College/University/Program Address *

Address Line 1

Address Line 2

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Personal accomplishments list of honors, leadership roles, and activities you have completed or are currently undertaking in school or local community. Please include years of involvement.

Copy of high school transcript (PDF)

Click or drag a file to this area to upload.

Letters of Recommendation from a township supervisor (pdf)

Click or drag a file to this area to upload.

Letters of Recommendation from non-township staff

Click or drag a file to this area to upload.

Upload Essay, Essays must be at least 500 words

Click or drag a file to this area to upload.

Certification

I hereby certify that the information provided is truthful and accurate to the best of my knowledge. I hereby apply for (choose only one): *Local Government Achievement ScholarshipAcademic Achievement Scholarship

Release of Information

By submitting the Pennsylvania State Association of Township Supervisors (PSATS) scholarship application form you are giving your consent for PSATS to release your personal information to the Scholarship Review Panel to consider you for scholarships on behalf of PSATS. This includes, but is not limited to, your application information, essay, and transcripts. Should you be elected to receive a scholarship, PSATS may request updates of your progress including GPA, classes taken, etc. Submission of this form confirms you agree to these terms and conditions. *

• I have read and agree to the above terms and conditions.

Submit