PSSO Education Assistance Fund Application
Name _________________________________________________________________________________
(Last, First, Middle Initial)

Address ___________________________________________________________________________________________
(Street, City and State Zip Code)

Department _________________________________________________________________________________________
Name (please write out) Room and Building Phone (work)

____________________________________________________________________________________________
Social Security Number, Major, Degree Pursued

Request for $________ o Books (please include copies of receipt[s])
  $________ o Tuition/Fees (please include a copy of your billing schedule statement)

Semester/Session applying for: ____________________________________________________________________
                                                       Semester and year, Total credit hours, Status (fresh, soph, jr, or earned to date senior)

Participation in PSSO committees: (Be specific, use the back of this form if more room is needed, and include date [year] of participation) ___________________________________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________________________________

Participation in PSSO Activities: (Be specific, use the back of this form if more room is needed, and include date[year] of participation)
_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

PSSO member since: ____________________________

Recipients of the PSSO Education Assistance Fund will receive an award based on availability of funds. The maximum amount of the award is $250. Recipients may receive this award for two consecutive semesters and/or sessions per classification status (freshmen, 0-25 credit hours, sophomore, 25-55 credit hours, junior, 56-87 credit hours, senior, 88+ credit hours.) An application must be submitted for each semester or session a PSSO member wishes to be considered for an award.

Applicants for the award must be:

 ____________________________________________ Signature & Date

Applicants are asked to complete this form and return it to: PSSO Scholarship Committee, c/o Ann McNees, Accounts Payable, Mail Stop 5208, no later than seven days after the first day of the semester.


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 Last Updated: November 30, 2005