Ann T. Bicknell Memorial

Scholarship Application

Name  ________________________________________________________

Campus Address  ________________________________________________

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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

__________________________________________________________________________________

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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.