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: ___________________



C. Please enclose the following:


1. Transcripts of your most recent two or more years of academic work. Photocopies are



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.


3. Three letters of recommendation: (a) from a teacher or administrator of your current or

most recently attended school, (b) from a Dickinson family member (usually the sponsor

listed above), and (c) from 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



Scholarship Scholarship Information