APPLICATION FOR RACIAL ETHNIC SCHOLARSHIP FUNDS
Synod of the Covenant,
Presbyterian Church (
Last First Birthdate
________________________________________________________________________________﴾______﴿________________________
Street Address City State Zip Telephone
_______________________________________________________________________________________________________________
Presbyterian Church Affiliation Address City State Zip
Are
you a member of the above named church? Yes No (Please
Circle)
Circle
last year completed 1 2
3 4 1
2 1
2 3 4
College
Year Vocational
Year Seminary Year
Student
Information
Are
you a Presbyterian? ___Yes ___No
Are
you living with parents/guardians? _______________________
Are
you head of household? ________ Number
of your dependents __________________________
How
many of your dependents in school? ______________
How
many of your dependents are in college? __________
Your
anticipated income for school year?
$____________ Amount
requested $________________
___________________________________ __________________________________________
Name educational institution Date
enrolled
___________________________________ __________________________________________
Major degree or certificate pursued Expected
graduation date
Total
educational expenses for school year? _______________________________
How
did you find out about this scholarship?
________________________________________________
Have
you received assistance from the synod before? _________(If yes, you must give dates
and amounts below)
List
verified financial resources available for your current academic year:
Employment
$_________________ Loans ______________
$__________________
Veterans Benefits $_________________ ______________ $__________________
Family $_________________ Grants______________
$___________________
Other: $_________________ ______________ $___________________
(please specify church,
savings, presbytery, etc. Total amount
of resources $________________
THIS FORM MUST BE SIGNED BY THE PERSON WHOSE FILE IS
TO BE DISCLOSED.
I, ______________________________________, AUTHORIZE
THE DISCLOSURE OF MY FILE TO THE SYNOD OF THE COVENANT FOR THE
PURPOSE OF DETERMINING MY ELIGIBITY FOR SCHOLARSHIP ASSISTANCE.
Revised 04/08