Scholarship Application Form

If you are interested in applying for this scholarship, complete the following application form to its entirety and send a copy of your resume
and one letter of recommendation to the address listed below.

Scholarship Name: Frank Blaise Modruson and Lynne C. Shigley Scholarship
Preferred address for donor contact:
Local address:
Home telephone:
Local telephone:
Campus: Major:
Semester standing: CUM GPA: (Current)
Graduation Date:
Email address:

I have asked the following person to write a letter of recommendation:
(name and title)

I am a volunteer firefighter and I have asked the fire chief to send a letter of recommendation to

Statement of why you are interested in applying for this scholarship, career goals, your interests in
Engineering, and participation in related activities.

YOU MUST INDICATE YOUR APPROVAL FOR THE FOLLOWING in accordance with the Family Educational Rights and Privacy Act of 1974 (FERPA).
I understand that consideration for this award is not dependent upon waiving my privacy rights and I have the right not to consent to the release of my resume.

Check here to grant the College of Engineering permission to share your resume for the purpose of updating my donor.
Check here to grant permission to the University to publicly announce my selection as a scholarship recipient.

Mail to:   Undergraduate Dean's Office
College of Engineering
101 Hammond Building
University Park, PA 16802-1400
(814) 863-3750; FAX (814) 863-4749