Polish National Alliance
Scholarship Award Program
2011-2012
The Silver Bell Club is pleased to make available scholarship applications to qualified members who are enrolled as full time college or university students who will continue their undergraduate studies in the fall semester.
Rules and Regulations
1. Only full time sophomores, juniors or seniors qualify to apply for scholarships. Incoming freshman do not qualify.
2. To be eligible to participate in the Scholarship Program the applicant must be a beneficial premium paying member in good standing of the PNA and Silver Bell Club.
a. Applicants joining PNA after January 1, 2002 in order to qualify for the scholarship must have a premium paying permanent plan of insurance
· Universal Life
· Ordinary Life
· Executive Life Paid Up at 90
· Life Paid Up at 65
· 20 Pay Life
· Single Premium Whole Life
b. Insurance must be in place prior to and no later than time of application.
3. The application must include the following:
a. A completed application signed by the Applicant and Parent or Legal Guardian
b. Most recent Official College or University Transcript. Copies and Grade reports will not
be accepted (If not available with application, then one must be received by February 20,
2012. Unofficial computer printouts will not be accepted. Without an official transcript
the application is incomplete and therefore, will be DISQUALIFIED.
c. Recent Photo (Wallet size please)
4. The completed application must be sent to the Silver Bell Club no later than February 20,
2012 Applications should be mailed to Silver Bell Club at PO Box 162 Hobart, IN 46342.
5. Scholarships will be awarded for studies and programs only in the U.S. and/or administered
by U.S. Colleges and Universities. Eligibility is limited to students in under graduate programs at four year accredited Colleges and Universities.
6. In determining the recipients, the Scholarship Committee will take into consideration the applicant’s academic record, educational goals, involvement in fraternal and youth activities of
the PNA as well as family PNA membership, church, community or college activities. The
evaluation will be on a cumulative point system. GPA below 2.0 will not qualify.
7. All applicants will be notified of the committee decision in February. All scholarships will be awarded to the student at the Silver Bell Club Installation Banquet. The student will be
notified of the banquet time and place.
8. Applicants are advised that any false or misleading information or statement may result
in permanent disqualification from participation in the Scholarship Program.
9. A Silver Bell Scholarship recipient must be a beneficial PNA member at the time any award is paid. In addition, a recipient must be a member for a minimum of 5 years after the last award is received. If membership is not retained, all awards received must be repaid.
10. Scholarships will be applied for and awarded on an annual basis. Eligibility per student islimited to 3 years. SCHOLARSHIP AMOUNT IS $500 PER YEAR.
DEADLINE February 20, 2012
Questions or more information, please contact Phil Furman 219-662-7739
Application for Scholarship Award
Silver Bell Club
PO Box 162
Hobart, Indiana 46342
ALL QUESTIONS MUST BE ANSWERED IN FULL. INCOMPLETE APPLICATIONS WILL BE DISQUALIFIED. APPLICATION SUBMISSION DEADLINE IS February 20, 2012. ALL INFORMATION WILL BE HELD IN STRICT CONFIDENCE.
1. Applicant’s Name ____________________________________________________________________________
Last First Middle SS#
2. Address ____________________________________________________________________________________
Street City State, Zip Telephone#
3. Date of Birth ___________________________ Place of Birth _________________________________________
4. P.N.A. Membership Information: Lodge No. ____________ Cert. No. ___________ Date of Entry ____________
5. In the Fall Semester I will be a: Sophomore_______ Junior __________ Senior ___________
Attached is a copy of my most recent University College transcript: Yes __________ No _________
The Transcript must be received by the SILVER BELL CLUB before January 15th otherwise the application will not be considered.
6. Name and Address of School you will attend in the Fall: ___________________________________________
7. Cumulative Grade Point Average __________________________
8. Applicants’ Major ______________________________________
9. Estimated Annual Tuition Cost $___________________________
10. Have you taken part in any Community, Church, Organization and/or School Activities reflecting the Polish Heritage: (Singing, Dance Group, Polish Language Study, Polish Scouts etc. ) Please list your activities.
_____________________________________________________________________________________________
_____________________________________________________________________________________________
11. Please list other college activities, hobbies, awards etc.
_____________________________________________________________________________________________
12. Have you previously received a scholarship award from P.N.A. Yes___________ No______________
If yes what year? ____________ Amount $______________
13. Your father or guardian name ________________________________________________________________
Is he a member of P.N.A. Yes__________ No___________
Lodge No. ___________ Certificate No. _________________ Date of Entry __________
14. Your mother or guardian name ________________________________________________________________
Is she a member of P.N.A. Yes ___________ No ___________
Lodge No. ___________ Certificate No. ________________ Date of Entry __________
15. Parental P.N.A. activities ______________________________________________________________________
16. Total number of children in family (including yourself) ________ Do they belong to PNA? Yes _____ No _____
Name Age Certificate No.
_____________________________________________________________________________________
_____________________________________________________________________________________
This application for scholarship is submitted with full knowledge of the rules and regulations determining the program. If a scholarship is awarded, the recipient pledges to abide by these rules.
Date __________ _____________________________________________________
Applicant’s Signature
Date __________ _____________________________________________________
Parent signature
Date _________ _____________________________________________________
Lodge President’s Signature
Date __________ _____________________________________________________
Lodge Secretary’s Signature
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