Ann T. Bicknell
Memorial
Scholarship
Application
Name
________________________________________________________
Campus Address
________________________________________________
______________________________________________________________
______________________________________________________________
Telephone (_____) - _______ - ______________
Social Security Number _______ - _____ - _______
Declared Major
__________________________________________________
O Undergraduate Student
O
Graduate Student
Anticipated Graduation Date
__________________________________________
Credits Completed at End of Current Semester
____________________________
Service to University
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Service to Community
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Please return completed application and three letters of
recommendation along with a written statement (1500 words)
indicating your professional plans and aspirations and justifying
your candidacy for the award to: Bicknell Scholarship
Selection Committee, Gerontology Program, 216G Strain Behavioral
Science Building, Slippery Rock University, Slippery Rock, PA
16057. Tel. (724) 738-2050. All application
materials must be received by March 15.
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