The Reverend Doctor John Q. Gibbs Scholarship
Parent(s)/Guardian(s )Name
First Name
Last Name
Parent(s)/Guardian(s) Email Address
example@example.com
Student Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Phone Number (Include Area Code)
Date of Birth
/
Month
/
Day
Year
Date
Graduate’s Email Address
example@example.com
High School (Include City and State)
Date of Graduation
/
Month
/
Day
Year
Date
High School and Community Clubs, Organizations & Activities:
List the student clubs, organizations or activities (e.g., extracurricular) you have been actively involved with over the past four years.
Club, Organization or Activity
Years of Participation (Include Dates)
/
Month
/
Day
Year
Date
Office/Position Held
Club, Organization or Activity
Years of Participation (Include Dates)
/
Month
/
Day
Year
Date
Office/Position Held
Club, Organization or Activity
Years of Participation (Include Dates)
/
Month
/
Day
Year
Date
Office/Position Held
Club, Organization or Activity
Years of Participation (Include Dates)
/
Month
/
Day
Year
Date
Office/Position Held
Honors and Awards:
List any honors or awards you have received within the past four years.
Honor/Award
Date Received
/
Month
/
Day
Year
Date
Honor/Award
Date Received
/
Month
/
Day
Year
Date
Honor/Award
Date Received
/
Month
/
Day
Year
Date
Other Scholarships Received (Include Date(s) Received)
Antioch Baptist Church Ministries in Which You Actively Serve(d)
Have you been accepted to a four-year college or university, specialty school, or community college?
YES
NO
If so, what school will you be attending, Name of Institution (Include City and State)
Major/Minor
Professional Goals
Additional Information: Please provide any additional information you would like the selection committee to consider while reviewing your application (including but not limited to: first-generation college student; cumulative GPA; ACT or SAT score; student service hours earned; high school or community-related activities or recognitions; employment opportunities.
Word Essay (500-650 words): Please discuss how you know you are saved. In addition, please describe how your relationship with Christ has changed/impacted your life.
Please provide a high resolution scan of a picture to be use for our graduation program when you submit your application.
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