Please complete the following information fully and submit to the Phi Psi Foundation. If you have any specific questions, not already answered, please contact us by phone at 800.350.1852, or by e-mail at Scholarships@PKPFoundation.org.

In order to save your application and return to it later, click on Member Login. If you have yet to do so, you will create a Connect account. This will allow you to log back into the website, and you will then click on "Scholarships", "National Scholarships", and "Scholarship Application". After you complete each step and click "Next Step", your application is automatically saved. To retrieve your application, follow the steps above and a "Resume" button will appear. Click on that button and the information from your last session will be restored to the form. Once your information is restored, click "Next Step" until you find where you left off the last time. Please feel free to contact Scholarships@PKPFoundation.org if you have any questions about this new process.

NOTE: During the online scholarship application process you will be asked to answer several essay questions. It is recommended that you use word processing software to compose and save your answers to these questions prior to beginning this application. A summary of the substance of these questions follows:

• Itemize in order of importance to you, all honors, awards and/or areas in which you have distinguished yourself.
• In 500 words or less please indicate your long-term education and employment goals. How will this award help you?
• What do you consider the most significant contribution you have made to your Fraternity, campus or community?
• Itemize other college or community activities and organizations to which you currently belong or in which you have previously participated. Be certain to note offices held/leadership positions.
• Why are you most deserving of this award?

Also, this application will be directed to our selection committee, with little or no editing. You may want to double-check for accuracy, grammar and spelling before you click the "Send Application" button.

General Information
First Name *
Middle Name
Last Name *
Suffix
Status *	Select Undergraduate Student Graduate Student Full-time Employment
Chapter *	Select Alabama Alpha Alabama Beta Arizona Alpha Arizona Beta Arkansas Alpha Ball State University Colony BigFish Test California Alpha California Beta California Delta California Epsilon California Eta California Gamma California Iota California Kappa California Lambda California Mu California Nu California Theta California Xi California Zeta Colorado Alpha Connecticut Alpha Delaware Alpha District of Columbia Alpha Florida Alpha Florida Beta Georgia Alpha Georgia Beta Illinois Alpha Illinois Beta Illinois Delta Illinois Epsilon Illinois Eta Illinois Gamma Illinois Iota Illinois Theta Illinois Zeta Indiana Alpha Indiana Beta Indiana Delta Indiana Epsilon Indiana Eta Indiana Gamma Indiana Theta Indiana Zeta Iowa Alpha Iowa Beta Iowa Delta Iowa Gamma Kansas Alpha Kentucky Alpha Kentucky Beta Louisiana Alpha Louisiana Beta Louisiana Gamma Maryland Alpha Maryland Beta Maryland Gamma Massachusetts Alpha Massachusetts Beta Michigan Alpha Michigan Beta Minnesota Alpha Minnesota Beta Minnesota Delta Minnesota Gamma Mississippi Alpha Mississippi Beta Missouri Alpha Missouri Beta Montana Alpha Nebraska Alpha Nebraska Beta New Hampshire Alpha New Jersey Alpha New Jersey Beta New Jersey Delta New Jersey Epsilon New Jersey Gamma New Mexico Alpha New York Alpha New York Beta New York Delta New York Epsilon New York Eta New York Gamma New York Iota New York Kappa New York Theta New York Zeta North Carolina Alpha North Carolina Beta Ohio Alpha Ohio Beta Ohio Delta Ohio Epsilon Ohio Eta Ohio Gamma Ohio Iota Ohio Kappa Ohio Lambda Ohio Mu Ohio Nu Ohio Omicron Ohio Theta Ohio Xi Ohio Zeta Oklahoma Alpha Oklahoma Beta Oregon Alpha Oregon Beta Pennsylvania Alpha Pennsylvania Beta Pennsylvania Delta Pennsylvania Epsilon Pennsylvania Eta Pennsylvania Gamma Pennsylvania Iota Pennsylvania Kappa Pennsylvania Lambda Pennsylvania Mu Pennsylvania Nu Pennsylvania Omicron Pennsylvania Phi Pennsylvania Pi Pennsylvania Rho Pennsylvania Sigma Pennsylvania Tau Pennsylvania Theta Pennsylvania Upsilon Pennsylvania Xi Pennsylvania Zeta Rhode Island Alpha Rhode Island Beta Rutgers Colony South Carolina Alpha Tennesse Alpha Tennessee Beta Tennessee Delta Tennessee Epsilon Tennessee Gamma Tennessee Zeta Texas Alpha Texas Beta Texas Delta Texas Epsilon Texas Gamma Texas Zeta University of Houston Colony University of Wisconsin Colony Vanderbilt University Colony Virginia Alpha Virginia Beta Virginia Commonwealth Colony Virginia Delta Virginia Epsilon Virginia Gamma Virginia Zeta Washington Alpha West Virginia Alpha Wisconsin Alpha Wisconsin Beta Wisconsin Gamma
School *	Select University of Alabama Auburn University University of Arizona Arizona State University University of Arkansas Ball State University Little Pond University University of the Pacific Stanford University University of Southern California University of California, Los Angeles California Polytechnic State University University of California, Berkeley University of California, Davis University of California, Irvine San Diego State University Occidental College University of California, Riverside California State University, Northridge California State University, Long Beach University of California, Santa Barbara University of Colorado Trinity College University of Delaware George Washington University Florida State University University of Florida University of Georgia Georgia Institute of Technology Northwestern University University of Chicago University of Illinois, Urbana-Champaign Illinois State University Southern Illinois University, Edwardsville Monmouth College Northern Illinois University University of Illinois, Chicago DePaul University DePauw University Indiana University Purdue University Valparaiso University Indiana State University Wabash College Indiana University-Purdue University,Indianapolis Butler University University of Iowa Iowa State University Simpson College Cornell College University of Kansas Transylvania University University of Kentucky Louisiana State University University of Louisana at Lafayette Loyola University New Orleans Johns Hopkins University The University of Maryland, Baltimore County University of Maryland - College Park Amherst College Brandeis University University of Michigan Michigan State University Carleton College University of Minnesota, Twin Cities University of Minnesota, Duluth Minnesota State University, Mankato University of Mississippi Mississippi College University of Missouri, Columbia Westminster College University of Montana University of Nebraska Creighton University Dartmouth College Rider University Monmouth University The College of New Jersey Rowan University Rutgers, The State University of New Jersey Eastern New Mexico University Cornell University Syracuse University Hobart and William Smith Colleges Colgate University State University of New York at Buffalo Columbia University State University of New York at Binghamton State University of New York College at Oneonta Rochester Institute of Technology Polytechnic University Duke University East Carolina University Ohio Wesleyan University Wittenberg University The Ohio State University Case Western Reserve University University of Toledo The College of Wooster University of Akron Kent State University Miami University University of Dayton Ohio University Muskingum University Ashland University Capital University Bowling Green State University University of Oklahoma Oklahoma State University University of Oregon Oregon State University Washington & Jefferson College Allegheny College Washington College Gettysburg College Franklin & Marshall College Bucknell University University of Pennsylvania Swarthmore College Pennsylvania State University Carnegie Mellon University Indiana University of Pennsylvania Lehigh University Lycoming College Temple University York College of Pennsylvania University of the Sciences in Philadelphia Penn State Altoona Lafayette College Drexel University Edinboro University Dickinson College Brown University University of Rhode Island Rutgers, The State University of New Jersey University of South Carolina LaGrange Synodical College Cumberland University Vanderbilt University University of Tennessee Nashville University University of Memphis University of Texas Texas Tech University Southern Methodist University Stephen F. Austin State University Texas State University, San Marcos Houston Baptist University University of Houston University of Wisconsin Vanderbilt University University of Virginia Washington & Lee University Virginia Commonwealth University Bethany College Randolph-Macon College Hampden-Sydney College Virginia Polytechnic Institute & State University University of Washington West Virginia University University of Wisconsin Racine College Beloit College
Initiation Year *
Year In School *	Select Freshman Sophomore Junior Senior Post-graduate
Phone *
Mobile Phone
E-mail *
Date of Birth * (mm/dd/yyyy)
Parent Name(s) *

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