APPLICATION FOR EDUCATIONAL SCHOLARSHIP
EPWORTH UNITED METHODIST CHURCH
9008 Rosemont Drive
Gaithersburg, Maryland 20877
(301) 926-0424 fax: (301) 926-0383
Date of
Application___________________
Name:___________________________________________________Age_________ Soc. Sec. No._____________________________________
Date of Birth: ___/____/____
I
have been a member of Epworth
since__________________________________________________
FAMILY INFORMATION
Name of Father:______________________________________________________________________Phone(s) ____________________________
Name of Mother:_____________________________________________________________________Phone(s) _____________________________
Parents' Home Address:___________________________________________________________________________________________________
______________________________________________________________________________________________________________________
Applicant's Address, if other than Home
(above)__________________________________________________________________________________
_______________________________________________________________________________________________________________________
Applicant's Phone(s):_______________________________________________________________________________________________________
CHURCH AND COMMUNITY ACTIVITIES DURING THE LAST 3 YEARS
_______________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
COLLEGE* PLANS
*The term "college" shall also include university or vocational school for the purposes of this application
Name of College You Are Attending or Planning to
Attend:__________________________________________________________________________
Address:________________________________________________________________________________________________________________
What Career Do You Plan to Enter, or What Careers are You
Considering?_____________________________________________________________
_______________________________________________________________________________________________________________________
Major or Course of Study:___________________________________________________________________________________________________
Name of Degree or Certificate:________________________________________________________________________________________________
RECORD OF EDUCATION
Name of High School Attended: _______________________________________________________________________________________________
Address of School:
________________________________________________________________________________________________________
Date of Graduation:________________________________________________________________________________________________________
Do You Have a GED or Equivalent?: _________________________________Date Taken:________________________________________________
Give a brief description of your goals for the future and how your
participation in Church and your Faith Journey has affected the
important choices you've made in your
life:______________________________________________________________________________________________________
____________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
Other Scholarship Money Received or Applied
for:_________________________________________________________________________________
_______________________________________________________________________________________________________________________
Scholarship Committee use only:
Date Reviewed: _______________________ Date Approved: _________________________
Reviewed by: _________________________________________________________________
Approved by (signature): ________________________________________________________
Scholarship Name:_____________________________________________________________
Amount of Scholarship:____________________ Year of Scholarship:____________________
Explain Source(s) of Funding: ____________________________________________________
_____________________________________________________________________________