Graduate Recognition Registration Form

TRINITY UNITED CHURCH OF CHRIST SCHOLARSHIP AWARDS & GRADUATE RECOGNITION
400 West 95th Street Chicago, IL 60628
Rev. Dr. Otis Moss III, Senior Pastor
Rev. Dr. Jeremiah A. Wright, Jr., Pastor Emeritus
Monica Allen & Georgette Greenlee, Co-Chairs applications@trinitychicago.org ||773 962 - 5650
Graduate Recognition Registration Form
(For Trinity United Church of Christ Members Only)
PLEASE PRINT CLEARLY
CHECK ONE:
Did you apply for a scholarship?
GIVING #
Name of Scholarship:
Any Special Needs:
Name:

First NameLast Name
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
EMAIL:
example@example.com
PHONE:
Format: (000) 000-0000.
Can this telephone number accept text messages?
GRADUATING FROM: (NAME OF SCHOOL)
PLANNING TO ATTEND: (NAME OF SCHOOL)
CITY

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Should be Empty: