Leadership Venango Scholarship Form

Please complete the form below to apply for a scholarship for the Leadership Venango program. Forms are due by Monday, August 14.

Which scholarship(s) are you applying for? (check all that apply) *

Be Here ($475) - Applicant must live and/or work in Venango County FLEX ($475) - Applicant must be a member of the FLEX young professionals group Other ($475-$950) - Community members/businesses have provided funds for additional scholarships; no qualifications are necessary other than an attached essay (see below)

First Name *

Last Name *

Email Address *

Work Phone

Cell Phone *

Employer/Organization *

Will you still complete this program if you do not receive a scholarship? *

Yes No

Essay *

In 200 words or less, share why you are deserving of this scholarship, and how you plan to use what you gain from this program in our region.

Additional Comments