Liberty Partnerships Program Scholarship
STATEMENT OF PARTICIPATION
Clarkson University has established a scholarship to benefit students that are active Liberty Partnerships
Program participants, in recognition of their academic potential, involvement in community activities, and
leadership. Recipients of this scholarship will receive a 50% reduction of the tuition costs for up to four
years of undergraduate study upon enrollment at Clarkson University. The students must meet the
academic requirements for regular admission to Clarkson University, as well as maintain good academic
standing to retain the scholarship.
Deadline: This form must be submitted no later than February 15 prior to the term in which the student
begins enrollment (ex: February 15, 2013 for students entering Fall 2013).
To be completed by the student:
Name _______________________________________________________________________________
Address ______________________________________________________________________________
City __________________________________________ State _______________ Zip _______________
Telephone ( _____ ) ________________________ Social Security Number ________________________
High School __________________________________________________________________________
E-Mail ______________________________________________________________________________
To be completed by the LPP Director:
LPP Director ________________________________ Institution ________________________________
Office Telephone ____________________________ Student LPP Enrollment Date ________________
Describe all LPP activities or services received through LPP (in high school):
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
I certify that the LPP student listed is an active student in the Liberty Partnerships Program and
the information provided is accurate.
Signature of LPP Director
Date
Return to: Kara L. Pitts, Associate Dean of New Student Financial Aid, Clarkson University, Box 5605,
Potsdam, NY 13699-5605