APPLICATION CHECKLIST

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1 BUCKNELL COMMUNITY COLLEGE SCHOLARS PROGRAM APPLICATION CHECKLIST To apply to the Bucknell Counity College Scholars Progra, please subit the following ites to your counity college contact. Your application ust be coplete before it is reviewed. Bucknell Counity College Scholars Progra application bucknell.edu/counitycollegescholars FAFSA ( preferred) identifying your counity college and Bucknell (003238) fafsa.gov Copy of high school transcript (or GED certificate) Previous college transcripts (if applicable) Transcript request for fro your counity college Two letters of recoendation (at least one fro faculty) Signed copy of your parents 2014 federal incoe tax return. If you are 24+ years of age, you will be considered an independent student; only a signed copy of your 2014 tax return is needed. SAT or ACT score report, if available International Students: If you are an F-1 visa holder, you ust also subit... TOEFL or IELTS score report International Student Financial Aid Application (ISFAA) for. Available online at bucknell.edu/adissions/international-adissions/paying-for-bucknell.htl. Stateent fro your parents and/or docuents verifying faily incoe Currency converter for your hoe country currency. There are any currency converters online. Try: finance.yahoo.co/currency?u BCCSAPP 14/15

2 BUCKNELL COMMUNITY COLLEGE SCHOLARS PROGRAM INITIAL APPLICATION Please note: Acceptance to the Bucknell Counity College Scholars Progra does not guarantee adittance to Bucknell University. Scholars ust apply for adission to Bucknell after copleting the suer progra. See bucknell.edu/counitycollegescholars for ore inforation. PERSONAL DATA LEGAL NAME Last/Faily First Middle (coplete) Jr., etc. MALE FEMALE PREFERRED FIRST NAME FORMER LAST NAME(S) (if any) BIRTH DATE ADDRESS (print clearly) /dd/yyyy PERMANENT HOME ADDRESS Nuber and Street Apartent # HOME PHONE Area Code CELL PHONE Area Code CITIZENSHIP U.S. CITIZEN DUAL U.S. CITIZEN (Please specify other country of citizenship) U.S. PERMANENT RESIDENT VISA; Citizen of ALIEN REGISTRATION NUMBER OTHER CITIZENSHIP Country(ies) Visa Type POSSIBLE AREA(S) OF ACADEMIC CONCENTRATION/MAJOR(S) UNDECIDED OPTIONAL DATA The following ites are optional. No inforation you provide will be used in a discriinatory anner. PLACE OF BIRTH City State/Province Country If you wish to be identified with a particular ethnic group, please check all that apply: SOCIAL SECURITY NUMBER (if any) FIRST LANGUAGE (if other than English) LANGUAGE SPOKEN AT HOME MARITAL STATUS Never Married Married Widowed Separated Divorced (date) /dd/yyyy AFRICAN AMERICAN, AFRICAN, BLACK NATIVE AMERICAN, ALASKA NATIVE Date Enrolled Tribal Affiliation ASIAN AMERICAN Countries of faily s origin ASIAN (including Indian subcontinent) Countries of faily s origin HISPANIC, LATINO Countries of faily s origin MEXICAN AMERICAN, CHICANO NATIVE HAWAIIAN, PACIFIC ISLANDER PUERTO RICAN WHITE, CAUCASIAN OTHER (please specify) BCCSAPP 14/15-1

3 EDUCATIONAL DATA NAME OF HIGH SCHOOL FROM WHICH YOU GRADUATED DATE OF GRADUATION (or GED CERTIFICATION) Month Year TYPE OF SCHOOL PUBLIC INDEPENDENT PAROCHIAL HOME SCHOOL SCHOOL ADDRESS Nuber and Street CURRENT COLLEGE/UNIVERSITY List all colleges/universities at which you have taken courses for credit. Please subit an official transcript to your liaison at your counity college. COLLEGE/UNIVERSITY LOCATION (City, State/Province) DEGREE CANDIDATE? DATES ATTENDED DEGREE(S) EARNED YES YES YES NO NO NO EXTRACURRICULAR AND VOLUNTEER ACTIVITIES Please list your extracurricular, counity and faily activities and hobbies in the order of their interest to you. ACTIVITY APPROX. TIME SPENT Hours per Week POSITIONS HELD, HONORS WON, ETC. WORK EXPERIENCE Weeks per Year Please list any jobs you have held during the past three years. SPECIFIC NATURE OF WORK EMPLOYER APPROX. DATES HOURS PER WEEK APPROX. # OF BCCSAPP 14/15-2

4 REQUIRED INFORMATION 1. Have you ever been found responsible for a disciplinary violation at any school or college you have attended, whether related to acadeic isconduct or behavioral isconduct, that resulted in your probation, suspension, reoval, disissal or expulsion fro the institution? YES NO 1. Have you ever been convicted of a isdeeanor, felony or other crie? YES NO If you answered yes to either or both questions, please attach a separate sheet of paper that gives the approxiate date of each incident and explains the circustances. I authorize all high schools and colleges I ve attended to release all requested records and authorize review of y application for the adission process indicated on this for. Signature Date IMPORTANT NOTE TO THE APPLICANT Please subit your application and required essays to your counity college liaison. DO NOT subit these to Bucknell University, as it ay delay the processing of your application. SUBMIT TO: Counity College of Philadelphia Todd Jones counseling departent Eail: Phone: Garrett College Judy Carbone director of advising and acadeic success Eail: Phone: Harrisburg Area Counity College David Satterlee dean, student affairs Eail: Phone: Lehigh Carbon Counity College Virginia Mihalik transfer counselor/professor Eail: Phone: Montgoery County Counity College Kristin Fuler transfer counselor Eail: Phone: BCCSAPP 14/15-3

5 BUCKNELL REQUIRED ESSAY The students who attend Bucknell University have a passion for learning in a liberal arts environent. They are also deeply engaged in leadership, service and global understanding as ebers of a residential counity. In 500 words or less, please explain why you are interested in the Bucknell Counity College Scholars Progra. How would you contribute to the learning environent? What would you hope to gain fro the experience? BCCSAPP 14/15-4

6 BUCKNELL COMMUNITY COLLEGE SCHOLARS PROGRAM FACULTY RECOMMENDATION This section is to be filled in by the applicant. APPLICANT S LEGAL NAME PERMANENT HOME ADDRESS Last/Faily First Middle (coplete) Jr., etc. Nuber and Street Apartent # CURRENT COLLEGE/UNIVERSITY IMPORTANT PRIVACY NOTICE Under the ters of the Faily Education Rights and Privacy Act (FERPA) you WILL have access to your recoendation after you atriculate UNLESS at least one of the following is true: 1. Bucknell University does not save recoendations post-atriculation (see list at coonapp.org/ferpa). 2. You waive your right to access below: YES, I do waive y right to access, and I understand I will never see this recoendation. NO, I do not waive y right to access, and ay soeday choose to review this recoendation. Signature Date This section is to be filled in by the faculty eber. Dear Faculty Meber, The above naed applicant is applying for the Bucknell Counity College Scholars Progra. This progra carries a significant scholarship opportunity afforded by the generosity of Bucknell University. Working with Bucknell, we seek to identify applicants who have excelled acadeically, achieving at least a iniu cuulative 3.5 GPA in courses; deonstrated leadership and service potential outside of the classroo; and deonstrated financial need. Your recoendation will help the Selection Coittee identify the ost proising and deserving Scholars. For ore inforation on the progra, please see bucknell.edu/counitycollegescholars. Please offer your candid reflections, including specific exaples of the applicant s acadeic record and potential; his/her leadership and service potential; and his/her ability to benefit fro a bachelor s degree progra at a selective liberal arts institution. BACKGROUND INFORMATION How long have you known this student and in what context? (continued) BCCSAPP 14/15-5

7 BACKGROUND INFORMATION (cont.) What are the first words that coe to your ind to describe this student? List the courses you have taught this student, noting the level of course difficulty (100-level, 200-level, etc.). Please feel free to attach a signed letter of recoendation, preferably on institutional letterhead. FACULTY MEMBER S NAME (Mr./Ms./Dr./etc.) Please print or type. FACULTY MEMBER S TITLE SCHOOL SCHOOL ADDRESS Nuber and Street FACULTY S PHONE Area Code FACULTY S Signature Date IMPORTANT NOTE TO THE FACULTY MEMBER Please subit this for and any other supporting docuents, in a sealed envelope, to the appropriate counity college liaison below. Please place your signature across the flap after sealing your recoendation. SUBMIT TO: Counity College of Philadelphia Todd Jones counseling departent Eail: Phone: Garrett College Judy Carbone director of advising and acadeic success Eail: Phone: Harrisburg Area Counity College David Satterlee dean, student affairs Eail: Phone: Lehigh Carbon Counity College Virginia Mihalik transfer counselor/professor Eail: Phone: Montgoery County Counity College Kristin Fuler transfer counselor Eail: Phone: BCCSAPP 14/15-6

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