LEGACY Scholarship Interest Form
This form is to be completed by Brook members only who are currently seniors in high school. Legacy scholarship recipients must be active Brook members, who regularly attend ROCK services and/OR serve at The Brook.
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Is the student currently an active member of The Brook?
*
Please Select
Yes
No
Does the student regularly attend ROCK or serve on a ministry?
*
Please Select
Yes
No
If the student serves as a volunteer at The Brook, please indicate in which ministries below:
*
Student's Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent's Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Submit
Should be Empty: