Crosby Scholarship Registration Form

Thank you for your interest in Manlius Pebble Hill School's Crosby Scholarship Exam. Please complete the form below, then mail the $10 registration fee to Manlius Pebble Hill Scholarship Exam, 5300 Jamesville Road, DeWitt, New York 13214.

* Fields marked with an asterisk are required.

Name of Student *
Current Grade of Student *
Student Gender *	Female Male
Student Date of Birth *
In addition to applying for a Crosby Merit Scholarship, please consider me for the following scholarships (select as many as applicable):	Minority Performing Arts Child of Alumus, Manlius School Manlius Grad Yr: Child of Alumus/a, Pebble Hill School PH Grad Yr: Child of Alumus/a, Manlius Pebble Hill School MPH Grad Yr:
Current School District *
Parents' Names *
Address *
City *
State *
Zip *
Home Phone *
Work Phone *

ICEBOX NEWSLETTER DIRECTORY CONTACT CAMPUS TOUR NAVIANCE CALENDARS