APPLICATION
EDUCATORS SCHOLARSHIP PROGRAM
Bucknell University
Lewisburg, PA 17837
Bucknell ID Number: _________________
Applications may be completed for a full academic year (June 1 to May 31):
Year
Number of
Courses
Summer Session __________ __________
Fall Semester __________ __________
Spring Semester __________ __________
Email:Name: _________________________________________
Home address: _______________________________________ Phone #: _______________________
City, state, zip: ________________________________
last 4 digits of SSN: __________________
Employed By: _______________________________________ Position
Address: _______________________________________ Title: _______________________
City, state, zip: _______________________________________ Phone #: _______________________
Highest Degree Held: __________________________________________________
Conferred By (Name of Institution): __________________________________________________
Educational Objective:
Masters Degree in ____________________________________________________________
State Certification as ____________________________________________________________
Other ____________________________________________________________
Financial Subsidy Available from School District:
$____________________ per (Credit) (Course) or ____________________% of Tuition Charge
Other Conditions: ___________________________________________________________________________
__________________________________________________________________________________________
_________________________________________
Date SIGNATURE OF APPLICANT
CERTIFICATION:
I hereby certify that the above named applicant is employed by the School District or other educational
agency in the position specified. I further certify that the amount of financial subsidy specified is available
to the applicant subject in compliance with district policies.
______________ ____________________________________________ __________________________
Date Signature of Superintendent or other authorized official Title
xxx-xx-
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CONDITIONS OF SCHOLARSHIP AWARDS
**************************************************************
Scholarship Approval
_______________________________________________________ _____________
Authorized Bucknell Signature Date
ELIGIBILITY:
Applicants must be teachers or other professionals (counselors, psychologists, supervisors,
administrators, etc.) employed in public, private not-for-profit, or parochial elementary or secondary schools
or programs and must be enrolled at Bucknell University in an approved program of courses leading to a
Master’s degree or State certification in an area of specialization. Other educational objectives may be
considered but at the discretion of the University.
APPLICATION PROCEDURES:
Applications may be completed for a full academic year (June 1 to May 31). Completed applications should
be filed with the University one week prior to the start of classes.
Send completed applications to:
Bursar Services
Office of Finance
Bucknell University
Lewisburg, PA
17837
570-577-3733
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