Lady Gray Legacy
Scholarship Application
Scholarship Amount: 3 credit course (tuition only)
Student Name:
ID Number:
Permanent Street
Address:
City:
State:
Zip:
Cell Phone:
Home Phone:
Bucks Email:
Major:
Current
Total Credits
Enrollment Status:
Completed:
Scholarship Criteria:
The scholarship is open to all Bucks students who have a mobility disability and, at the time of application, receive
services from the Accessibility Office (TAO) at Bucks County Community College.
Applicants must have distinguished themselves by proving their motivation for self-improvement and/or personal
growth.
Applicants must be enrolled at least part time (minimum of 3 credits), and intend to return to Bucks in the following
academic year after the award is made and enroll in a minimum of 3 credits.
The student must provide the following:
o Identify your mobility-related disability and any assistive devices used for mobility.
o Describe your efforts to improve yourself (you may choose another person to respond to this statement via a
letter of support, or submit a one-page essay yourself).
There is no minimum grade point average required to apply.
I meet all of the scholarship criteria and have enclosed the required information with my application.
Student Signature:
Date:
Please return your completed application and supporting materials to:
The Accessibility Office Email: accessibilit
y@bucks.edu
It is the responsibility of the student to submit the form to the Accessibility Office (TAO) at Bucks County Community
College
where the student is enrolled. The student will submit the form to TAO. Students will also be required to
submit all supporting materials for the application when submitting the form.
TAO’s contact information is as follo
ws:
Phone: (215) 968-8182
Email: acc
essibility@bucks.edu
Office: Bucks County Community College
275 Swamp Road
Rollins Center • Student Services Office • Room 001
Newtown, Pennsylvania 18940
APPLICATION DEADLINE: April 1
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