Online Scholarship Application

Please fill in all information on the following online form. When clicking "Submit and Print" the information will be sent to the District 12 High School C/I Representative and your completed application will appear in a new window. Please print this completed form and mail it with your other application materials to:

Suzanne Dickinger
Conestoga HS
200 Irish Road
Berwyn, PA 19312

Applicant Name:
Telephone:
Applicant's E-mail:
Parent's E-mail:
Home Address:

City:
State:
Zip Code:
School:
School Address:

School City:
School State:
School Zip:
Director's Name:
MENC #:
Director's E-mail:
School Telephone:
College you will attend in the fall:
Admissions Address:

College City:
College State:
College Zip:

List the PMEA festivals in which you have participated, separated by commas. Please include years.


List all school musical activities in which you have participated, separated by commas.


List any other musical activities in which you have participated, separated by commas.


List any honors earned, both musical and academic, separated by commas.


By clicking "Submit and Print" I verify that all statements made are true and correct. I am aware of the criteria for award selection and agree to abide by the decisions of the scholarship committee.