Scholarship Request Form

Lange Memorial Scholarship Fund Application

SCHOLARSHIP APPLICANT INFORMATION:
Name

First NameLast Name
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail Address
Cell Phone Number

Area CodePhone Number
Age
PLEASE SHARE THE NAMES OF PARENTS, RELATIVES, OR OTHERS YOU HAVE A CLOSE RELATIONSHIP WITH AT EMANUEL CHURCH:
HIGH SCHOOL GRADUATED FROM OR SCHOOL PRESENTLY ATTENDING:
EDUCATION PLANS: Where will you be attending college/trade school/seminary? What is your intended major/course of study?
SCHOLARSHIP LEVEL - Please indicate one or both of the following:
High School Grade Point Average:
College Grade Point Average:
CHURCH PARTICIPATION: Include All Activities
SCHOOL PARTICIPATION:Include All Activities - Clubs, Volunteer Groups, Sports, Councils, etc.
ESSAY: Please share with us about your life, your passions, what drives you, and your goals for the future. (Please limit this essay to 500 words)

0/500
Signature
Date

MonthDayYear
Should be Empty:

Lange Memorial Scholarship Fund Application