Arts Merit Scholarship Registration Form

Please complete the following registration form. (All fields are required)

Arts area to which you are applying :

Prospective Student Information
First Name:
Last Name:
Gender:	Female:	Male:
Address:
City:
State:
Zip:
Country:

Home Phone Number:	( ) -
Cell Phone Number:	( ) -

Birth Date:	Day: Year:

Email (Required):
High School:
High School City and State:
High School Graduation Year:

Intended Major(s), if different from the arts area:
I will be applying to Bucknell: