Kingswood Scholarship Application Form
Kingswood United Methodist Church | 401 W. Dundee Rd. Buffalo Grove, IL 60089 | 847-398-0770 | harrybrubeck@yahoo.com
Personal Data
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth
-
Month
-
Day
Year
Date
Email
example@example.com
Phone Number
Please enter a valid phone number.
Parent/Guardian 1
First Name
Last Name
Parent/Guardian 1 Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian 2
First Name
Last Name
Parent/Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Siblings Names and Dates of Birth
Member or Associated with Kingswood since? (Please indicate month and year)
Education Data
High School Attended
Graduation Date (Mo/Yr)
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name of Post--Secondary School for Which Scholarship is Requested
Phone Number of Post-Secondary School
Please enter a valid phone number.
Address of Post-Secondary School
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Anticipated Graduation Date
-
Month
-
Day
Year
Date
Major Field of Study
Full-Time/Part-Time
Full-Time
Part-Time
Career Goal
Church, School, Community, and Work Involvement
Church Involvement: List all church activities in which you have actively participated. Please include the years in which you participated in these activities.
School and Community Activities: List all school and community activities in which you have participated during the past 4 years.
Work Experience. Describe your work experience during the past 4 years. Please include the length of time in which you worked there in addition to the hours you worked per week.
Attachment A - Essay for First Time Applicants
A two-part essay is required with your scholarship application. The topics for first time applicants are different than for previous applicants – please select the correct topic. Each part should consist of 250 - 600 words (1 – 2.5 pages double spaced). Please label each part. Essay topics: 1. “What Kingswood Means to Me”. 2. “What I Plan to do with My Education”.
File Upload - Essay for First Time Applicant
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Attachment B - Essay for Continuing Students
A two-part essay is required with your scholarship application. The topics for first time applicants are different than for previous applicants – please select the correct topic. Each part should consist of 250 - 600 words (or 1 – 2.5 pages double spaced). Please label each part. Essay topics: 1. “How my faith helped my Academic Journey this year”. 2. “What I learned about myself this past semester”.
File Upload - Essay for Continuing Student
Browse Files
Drag and drop files here
Choose a file
Cancel
of
References
Provide the following information for people you have asked to submit a letter of reference. Please include one adult non-family member and one from a current instructor. Please send the Kingswood UMC Reference form (https://form.jotform.com/223475129236053), which includes instructions, for your reference to upload and submit.
Name
First Name
Last Name
Occupation
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Instructor's Name
First Name
Last Name
Area of Teaching
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Transcript Information
Currently enrolled post-secondary students must include a transcript of grades from all institutions attended, dated within the past year. High School seniors or students who have completed less than one full semester of post-secondary education must include a high school transcript. Please send the Kingswood UMC Transcript form(https://form.jotform.com/241774017019050), which includes instructions, to your school career / counseling center to upload and submit.
Applicant Rank/Class Size
Cumulative GPA (A=4.0)
Picture
Please upload a recent picture (preferably a graduation picture) for publicity purposes.
File Upload
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Certification
In submitting this application, I certify that the information provided is complete and accurate to the best of my knowledge. Falsification of information may result in termination of any scholarship eligibility. I also agree that if I do not use the scholarship for the above-mentioned education, I will repay the scholarship in full to the appropriate scholarship fund.
Signature
Today's Date
-
Month
-
Day
Year
Date
Other Forms
Please feel free to upload anything else here before clicking the submit button below.
File Upload
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Submit
Should be Empty: