SCHOLARSHIP APPLICATION
FOR THE YEAR 2009
A. Name _____________________________ Telephone ( ) ______________
Address ________________________________________
City ___________________________State ______ Zip __________
Sponsor Name _________________________________
Address _________________________________
_________________________________
Note that the applicant and sponsor should both be descendants of
Nathaniel Dickinson (1600-1672)
B. Accredited Colleges or Universities Accepted?
to which you have applied
1. _______________________________________ ________
2. _______________________________________ ________
3. _______________________________________ ________
Other college applications may be listed on the reverse side of this form.
Academic year for which applications have been made: _ญญญ__________________
C. Please
enclose the following:
1. Transcripts of your most recent two or more years of academic work. Photocopies are
acceptable.
2. A 250-300 word essay in which you provide information about yourself, your
accomplishments, your educational and career goals, and the value of this scholarship
to you. Mention any involvement you or your close relatives have had with the
3. Three letters of recommendation: (a) from a teacher or administrator of your current or
most recently attended school, (b) from a
someone who knows you well but not in an academic or family context (e.g. an
employer, a clergyman, a leader of an organization to which you belong, etc.)
4. Evidence of acceptance to an accredited academic institution as a regular full-time
student in a degree program. Photocopies are acceptable.
5. Your family lineage, traced back at least to an entry in the book, DESCENDANTS OF
NATHANIEL DICKINSON