Scholarship Application Form

The Harold B. & Dorothy A. Snyder Foundation, Inc.

Scholarship Application Form

Permanent Address
Street City State Zip
Mailing Address at college
Email Address
Social Security No.
Date & Place of Birth

Father’s Name Or Husband
Phone Number
His Employer (of previous occupation if not presently working)
Yearly Gross Income (while working)
Mother’s Name Or Wife
Phone Number
His Employer (of previous occupation if not presently working)
Yearly Gross Income (while working)

I am a

I have the following degrees / licenses (include data received and from where)

My gross yearly income is $

How did you learn about the Harold B. & Dorothy A. Snyder Scholarships?

High School Attended
Name State Graduation Date
College for which aid is requested
Name State Graduation Date
School is     
I will be enrolled     
Upcoming year in school (circle)   Undergraduate                 Graduate  
Major/Minor field of study and degree sought
Other Institutions attended (Name, State, Dates, Program)
EXTRACURRICULAR ACTIVITIES (attach additional sheet if necessary)
List all school and community activities in which you have participated this year and last year - i.e., sports, student government, clubs, volunteer projects, etc.
Organization Dates
Honors Given
and/or Offices Held

WORK EXPERIENCE (Attach additional sheet if necessary):
List all paid work experiences you have had.  Include payments in kind.
Position Dates from   
Dates to
per Week 
Cash Earnings
and Benefits

In 500 words or less, please explain:

1. Do you think voluntary community service is important? If so, why? If not, why?
2. What does it mean to you to be a citizen of the United States?
3. How would you respond to this statement from the Charter of the Snyder Foundation?

“While it is not a condition of the scholarship awards, it is suggested the beneficiaries, upon completion of their studies and becoming gainfully employed, make contributions according to their abilities in, an amount which may be equal to or in excess of the amount expended on their behalf.”

FINANCIAL INFORMATION : List all Financial Aid (scholarships, grants, loans) you have applied for, are receiving, or have received in the past.
Source Dates Amount
Total size of parents’ household income during this current academic year.  (Include the student named on this form if a member of parents’ household.)
Family members in college during this current academic year (including yourself).
Provide information below for all children and other dependents.
Name Age Name of institution to be
attended in the Fall
Year in
school now

IMPORTANT: If you or your parents have submitted/plan to submit an application for financial aid through your school or another financial institution, submit a copy of all relevant FAF and FAFSA forms.


Market Value
Mortgage Principal
Home, if owned or being purchased
Year purchased
Purchase price
Other real estate
Investments (stocks, bonds, other securities) 
Business (include your share of all business assets)
Cash, savings, checking accounts  
Other indebtedness
By signing this application form, I hereby authorize the college I will attend to release copies of my transcript and information on financial aid awarded to me by the college and other sources to the Harold B. & Dorothy A. Snyder Foundation.  I / We certify that all the information submitted as part of this application is true and correct and that any scholarship awarded is subject to being paid back if any of the information is found to be inaccurate.
Student’s Signature
(or full name if applying online or by e-mail)
Legal Guardian or Spouse Signature Date

REFERENCES: On the lines below, provide the names, titles, full addresses, and phone numbers of the persons whom you would like to use as references for your application. Please contact each of these individuals and request that they send a letter of reference to the Snyder Foundation via e-mail to the attention of Joseph Vallone ( or via U.S. mail. These persons, not you, should forward the letters of reference to us, and they should arrive no later than March 15th. As a courtesy, you should provide each of these persons with an addressed and stamped envelope.
1. Your high school counselor or your current college faculty advisor.
2. A faculty member, under whom you have studied, from your major field of study.
3. A faculty member, under whom you have studied, outside your major field.
4. Your current or most recent employer.
What's New
What's New: The Snyder foundation is currently reviewing prospective applicants for grants and scholarships for 2011. Learn more about the application criteria and how to apply.
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