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Scholarship Release Form

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Use this form to submit your scholarship release form electronically.

First Name ■

Last Name ■

Penn State E-mail ■

Penn State ID Number ■

9 digits without spaces or dashes

Scholarship Name ■

Please select one choice in order to indicate the level of permissions you are giving to the college to publish your name in a list of scholarship recipients. * ■

Yes, I give my permission to the Eberly College of Science to publish my name in a list of scholarship recipients.
No, I do not give my permission to the Eberly College of Science to publish my name in a list of scholarship recipients.

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