CLARKSON UNIVERSITY SCHOLARSHIP



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Liberty Partnerships Program Scholarship

STATEMENT OF PARTICIPATION

Clarkson University has established a scholarship to benefit students that are active Liberty Partnerships Program participants, in recognition of their academic potential, involvement in community activities, and leadership. Recipients of this scholarship will receive a 50% reduction of the tuition costs for up to four years of undergraduate study upon enrollment at Clarkson University. The students must meet the academic requirements for regular admission to Clarkson University, as well as maintain good academic standing to retain the scholarship.

Deadline: This form must be submitted no later than February 15 prior to the term in which the student begins enrollment (ex: February 15, 2013 for students entering Fall 2013).

To be completed by the student:

Name _______________________________________________________________________________

Address ______________________________________________________________________________

City __________________________________________ State _______________ Zip _______________

Telephone ( _____ ) ________________________ Social Security Number ________________________

High School __________________________________________________________________________

E-Mail ______________________________________________________________________________

To be completed by the LPP Director:

LPP Director ________________________________ Institution ________________________________

Office Telephone ____________________________ Student LPP Enrollment Date ________________

Describe all LPP activities or services received through LPP (in high school):

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

I certify that the LPP student listed is an active student in the Liberty Partnerships Program and the information provided is accurate.

Signature of LPP Director Date

Return to: Kara L. Pitts, Associate Dean of New Student Financial Aid, Clarkson University, Box 5605, Potsdam, NY 13699-5605

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