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*

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Date*

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Lange Memorial Scholarship Fund Application