LYNCOURT WESLEYAN CHURCH

ANGIOLILLO SCHOLARSHIP FUND APPLICATION

                                                                                                                          Date: ___________________

PERSONAL INFORMATION

Full Name: _____________________________________________  Date of Birth: __________________

 

Home Address: ________________________________________________________________________

 

Mailing Address: _______________________________________________________________________

 

Home Phone: ___________________________ Cell Phone: _____________________________________

 

E-Mail Address: ________________________________________________________________________

 

EDUCATIONAL INSTITUTION AND COURSE OF STUDY

College you will attend this year: __________________________________________________________

 

Chosen course major(s) and minor(s): ______________________________________________________

 

Expected Degree: ______________________________________________________________________

 

Expected date of graduation: _____________________________________________________________

 

COMPLETED EDUCATION

What education level will you have completed by June 30^th of this year?

High School Graduate: ___ Yes   ___ No                

High School: _________________________________________________________________________

 

Undergraduate Work: ___ Year 1;  ___Year 2;  ___Year 3;  ___Year 4

        Graduation Degree: ________________________________________________________________

        Educational Institution: _____________________________________________________________

 

Post Graduate Work:  ___ Year 1;  ___ Year 2; ___ Year 3

        Post Graduate Degree: ______________________________________________________________

        Educational Institution: _____________________________________________________________

 

Other, explain: ________________________________________________________________________

        Educational Institution: _____________________________________________________________

 

Student’s savings to date for current year applied $___________ (subject to verification before award)

Student’s current student loan debt load $ __________________ (subject to verification before award)

 

Other funding sources: __________________________________________________________________________

Please attach your typed testimony and your transcript for the last school year completed.

 

I hearby verify this information to be true and valid to the best of my knowledge.  I know that knowingly submitting wrong information with the intent to mislead or misrepresent myself will be reason for my application to be rejected and I would lose all rights to apply to this fund again.

 

Signed: ___________________________________________________  Date: _____________________ 

                                                                                                                                                          Rev. 11-09