The Erie Community Foundation

The Barbara A. Chambers Ed. D. Scholarship of

The Erie Community Foundation

1. Name Birth date

2. Street address City State Zip

E-Mail address Phone

3. Annual household income $ No. dependents in household (include parents)

4. Guardian(s) Name(s)

Occupations(s)

5. High School

High School GPA U.S. Citizen Yes No

6. College you will be attending Gannon University Mercyhurst University Major field of study Projected graduation date

7. Please include the following required documents:

Ø Official transcript (MUST include senior year grades, rank, SAT/ACT Scores and absences/tardies.)

Ø Acceptance Letter verifying attendance

Ø 2 Academic letters of recommendation in a sealed envelope

Applicant Signature Date

Deadline: April 15th