SILVER BELL CLUB LODGE #2365 
   
MERRY CHRISTMAS TO ALL 
       
APPLICATION FOR SCHOLARSHIP 
                                    

         
Silver Bell Club – Polish National Alliance Scholarship Award Program
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, and/or sophomores 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 Polish National
Alliance (PNA) and Silver Bell Club.
a. Applicants joining after January 1, 2002 in order to qualify for the scholarship you must have a premium paying permanent plan of insurance.  Universal Life  Ordinary Life  Executive Life Paid up at 90  Single Premium Whole Life
Please note: Insurance must be in place prior to and no later than time of
application.
3. The application must be accompanied by the following materials for
consideration. Failure to do so may lead to disqualification from scholarship consideration.

b. Most recent Official College or University Transcript. Copies and grade reports will not be accepted. If Official Transcript is not available at the time application is sent in. c. Recent wallet size photo of applicant. 4. The completed application form must be sent to the Silver Bell Club Applications and accompany documents should be mailed to: Silver Bell Club Attn: 2017 Scholarship Committee PO Box 162 Hobart, Indiana 46342 5. Scholarships will be awarded for studies and programs only taking place in the U.S. and/or administered by U.S. colleges and universities. Eligibility is limited to students in undergraduate programs at four-years accredited colleges and universities. 6. In determining the recipients, the Scholarship Committee will take into consideration the applicant’s 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 accumulative point system. GPAs 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 Banquet. The student will be notified of the time and place. 8. Applicants are advice that any false or misleading information or statement may result in permanent disqualification from participation in the scholarship program. 9. A Silver Bell club Scholarship recipient must be a beneficial PNA members at the time any award is paid. Additionally, 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 warded on an annual basis. Eligibility per student is limited to 3 years. Scholarship Amount of $500 per year. Application for Scholarship Award All questions must be answered in full. Incomplete applications may be disqualified. Please type or write all answers legibly. 1. Applicant’s Full Name: _______________________________________________________________ 2. Address: __________________________________________________________________________ City: ________________________________State:_____________ Zip:_______________________ 3. Date of Birth: _______________________________ Place of Birth: ___________________________ 4. Telephone Number: __________________________ Social Security#:________________________ 5. PNA Membership Information: Lodge No. __________Cert. No.________ Date of entry:__________ 6. In the Fall semester I will be a: Sophomore  Junior  Senior  Attached is a copy of my most recent University/College transcript: Yes  No  NOTE: The transcript must be received by the Silver Bell Club. 7. Name and address of the school you will attend in the Fall: _________________________________ _____________________________________________________________________________________ 8. Cumulative GPA: ___________________ Applicant’s Major:______________________________ 9. Estimated Annual Tuition Cost: $_____________ 10. List all applicable community, church, organization, and /or school activities reflecting Polish heritage (such as choral/dance groups, Polish language study, Polish scouts, etc.) Attach additional pages as needed. _________________________________________________________________

_____________________________________________________________________________________

11. List all other college activities, hobbies, awards, etc. Attach additional pages as needed. _____________________________________________________________________________________

12. Have you previously received a scholarship award from PNA: Yes  No 
 If yes, list the year and amount of scholarship awarded: _______________________________________


13. Have you read and agree with the Rules and Regulations of the Scholarship Award Program? Yes  No 
I swear or affirm that the following information stated above for the Silver Bell Club Scholarship Award Program is accurate and truthful as to the best of my knowledge. _______________, 201_____ ____________________________________________

Signature of Applicant

Mail completed application and accompany documents to:


Silver Bell Club
Attn:2018 Scholarship Committee

PO Box 162
Hobart, Indiana 46342   

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