Scholarship Form

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Pastor's Name, Phone & Address

Provide name, address, and phone number for the Pastor of the local church which you currently attend.

Pastor's Name

First Last

Address

Street Address City State / Province / Region ZIP / Postal Code Country

Phone

References of two mediators

Provide name and phone number of two mediators. These people should not be related to you.

Name (First Mediator)

Full Name

Phone (First Mediator)

Name (First Mediator)

Full Name

Phone (First Mediator)

Other Information

What is your current role in ministry ?

Briefly state in 5-7 sentences why you need the scholarship and what you would do with the money:

Note: The form must be completed in its entirety to be considered for scholarship. Candidates are chosen by a committee based on need and availability. Winner(s) will be announced during the Discover Conference.