Ted Brickley and Bernice Shikora Scholarship

Are you enrolled in an accredited University majoring in a related EHS major?
YesNo

Are you a full time or part time undergraduate or graduate?
YesNo

Do you have a GPA between 2.50 – 4.00?
YesNo

Do you have a GPA above a 3.0 in environmental or safety courses on a 4.0 scale?
YesNo

Are you a New Jersey resident or attend a college in the State of New Jersey?
YesNo

Applicant Information
Full Name:

Street Address:

City/Town:

State:

Zip Code:

E-mail Address:

Phone Number:

Education
Name of college/university:

GPA:

Major:

Organizations involved with:

Class Standing: (by credits)
FreshmanSophomoreJuniorSeniorGraduate

Experience
Are you currently employed?
YesNo

Describe your role and experiences gained for your work experienced:

Describe your extracurricular activities such as volunteer work:

Further Requirements

Submit a brief biography about your interest, hobbies, and/or work experience

Submit a copy of your current transcript

Submit a reference letter from a high school teacher, University Professor, University Department Head, or Supervisor at a current job