Tannersville Lions Club Annual Scholarship

First Name*

Middle Name

Last Name*

Student ID*

ESU Campus Email*

Date Student Applied*

Device you are using to complete the form*

Monroe County service organization participation. You may provide up to three different organizations.

Service Organization 1

Service Organization 2

Service Organization 3

Pocono Mountain East High School graduate *

Questions should be directed to the ESU Foundation Scholarship Administrator lschaller@esufoundation.org or 570-422-3658.