LINCOLN UNIVERSITY

HORACE MANN BOND-LESLIE PINCKNEY HILL SCHOLARSHIP

ELIGIBILITY

Candidates must:

Be seniors or recent graduates (within the last five years).

Be accepted as full-time students in a professional program of medicine (including Podiatry), dentistry, or law at Pennsylvania State University, Temple University, or the University of Pittsburgh.

Be residents of Pennsylvania and citizens or permanent residents of the United States.

Be nominated by Lincoln University.

Demonstrate high academic performance and maintain satisfactory progress.

APPLICATION

RETURN TO: OFFIC OF INSTITUTIONAL RESEARCH, 206 LIVING LEARNING CENTER

Name of Student: ____________________________________________________ Today’s Date: ____/____/____

You are classified as a: ¨ Senior ¨ Junior ¨ Sophomore ¨ Freshman

¨ Recent Graduate Date of Graduation: ____/____/____ Degree: _____________________

Social Security #: _______________________ Cumulative GPA: _____________ Major: ____________________

Home Address: ______________________________________________________________________________

CITY _____________________________ STATE ___________________ ZIP ____________

Home Telephone: ( ) - Campus Extension: ____________ Campus Box: _____________

Are you a resident of Pennsylvania? ¨ Yes ¨ No If no, do you intend to be a resident within the next three years?

¨ Yes ¨ No

Are you a United States’ citizen? ¨ Yes ¨ No If no, have you applied for citizenship? ¨ Yes ¨ No

Have you taken the GRE? ¨ Yes ¨ No Score: ______________

If no, date you intend to take the GRE: ____/____/____

Have you taken the LSAT? ¨ Yes ¨ No Score: ______________

In no, date you intend to take the LSAT: ____/____/____

Have you taken the MCAT? ¨ Yes ¨ No Score: ______________

In no, date you intend to take the MCAT: ____/____/____

Discipline that you intend to study: ¨ Dentistry ¨ Law ¨ Medicine ¨ Podiatry

University(s) that you are applying (or have applied) to: ¨ Pennsylvania State University ¨ Temple University

¨ University of Pittsburgh ¨ Other ____________________________________________________

If you have applied, have you been accepted? ¨ Yes ¨ No

SIGNATURE ________________________________________________________________________________________

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