The Richard M Elseroad Scholarship Application

The Richard M Elseroad Scholarship Application
The deadline to receive completed Scholarship Application for Fall Enrollment is May 15^th.
The deadline to receive completed Scholarship Application for Spring Enrollment is September 15^th.
APPLICANT INFORMATION
Enrollment for:
Enrollment year
Legal Name

First NameMiddle Name (complete)Last NameSuffix
Nick Name

First NameLast Name
Birth Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Gender
Preferred Phone Number
Format: (000) 000-0000.
E-Mail address
example@example.com
Permanent Home address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Intended College/University to Enroll
Home Church (address) and Pastor's name:
Academic Interests
Career Interests
EDUCATION
Secondary Schools (Most recent secondary school attended)
Entry Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Graduation Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Counselor's Name

First NameLast Name
Counselor phone number
Format: (000) 000-0000.
Counselor email address
example@example.com

List all other secondary schools (if applicable) you have attended since 9th grade, including summer schools or enrichment programs

Colleges/university-affiliated courses taken since 9th grade

Rows	College/university, city/state/ZIP, dates attended (MM/YY)	Degrees earned
1
2
3

***Please have all applicable official transcripts sent to Grace Lutheran Church, attention Scholarship Committee
ACADEMICS
Class Rank (If available)
Class size
GPA
GPA scale
ACT exam date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
ACT best scores date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
ACT Composite
ACT English
ACT Math
ACT Reading
ACT Science
ACT Writing
SAT exam date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
SAT best scores date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
SAT Reading
SAT Math
SAT Writing

Current courses: include course name, level (AP, Advanced, Honors), and credit value

EXTRACURRICULAR ACTIVITIES & WORK EXPERIENCE
Please list your principal extracurricular, volunteer, and work activities in their order of importance to you. Provide details of your activities and accomplishments (specific events, varsity letter, musical instrument, employer, etc.).

EXTRACURRICULAR ACTIVITIES & WORK EXPERIENCE

Rows	Grade levels (9, 10, 11, 12)	Hours per week / Weeks per year	School year / Summer	Activity and accomplishments
1
2
3
4
5
6
7

WRITING
Briefly elaborate on one extracurricular activity or work experience. Discuss why it was such a significant experience or achievement (200 to 300 words). Enter your response in the Writing field below.
Writing: significant activity or work experience (200–300 words)

Briefly elaborate on one extracurricular activity or work experience and explain why it was significant. Enter 200 to 300 words.0/300
PERSONAL TESTIMONY
Please provide your personal testimony as to why you believe you have been drawn to pursue a career path in Christian ministry. Enter your response in the Personal testimony field below.
Personal testimony
Please explain why you believe you have been drawn to pursue a career path in Christian ministry.
Language proficiencies: list each language and whether you speak, read, and/or write it
Current mailing address, if different from your permanent home address
Other secondary schools since 9th grade, including summer schools or enrichment programs: school name, city/state/ZIP, and dates attended (MM/YY)
Phone type (Home, Cell, or Both); if Both, provide your additional number
Do you grant permission for us to conduct a background check?
SIGNATURE
I certify that all information submitted in this application is my work, factually true, and honestly presented.
Signature
Signature date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

EXTRACURRICULAR ACTIVITIES & WORK EXPERIENCE