Partner University Scholarship Application

Name(Required)

First Last

Phone

Email(Required)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Which partner university do you currently attend?

University Contact

(Staff member who nominated you for Scholarship)

University Contact Email

Please check all that apply

I am an LGBTQ+ applicant

I am a BIPOC applicant

I am a resident of the Garfield Neighborhood of Pittsburgh

Class Choice

We do our very best to get our University Partner students enrolled into their first choice class. However, sometimes we are not able to accommodate every first choice. Please provide up to 3 class choices you wish to attend. Please use both course name and instructor name when filling out this section.

First Choice Class(Required)

Second Choice Class

Third Choice Class