Application for Scholarship

Applicant's Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Date of Birth*

Social Security Number*

Phone*

Father's Name

First Last

Father's Occupation

Mother's Name

First Last

Mother's Occupation

Name of Your High School*

Date of Graduation*

College You Will Attend*

Student ID Number*

Address of College Attending*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Contact Person at College*

First Last

Awards/Recognition You Have Received*

Extracurricular Activities In Which You Participated*

Leadership Positions You Have Held*

Other Activities You Participated In, Which Are Not Related to School*

How you have participated in the life of Ormond Beach Presbyterian Church?*

How many times have you attended service or church activity in the past year?*

What are your goals and objectives as you pursue higher education?*

I understand that for this application to be considered complete I must provide my current transcript to: Ormond Beach Presbyterian Church, ATTN: Scholarship Committee, 105 Amsden Road, Ormond Beach, FL 32176

I understand that for this application to be considered complete I must provide TWO letters of recommendation 1) from a member of the staff from school 2) from a non-related individual. Both letters to be sent to: Ormond Beach Presbyterian Church, ATTN: Scholarship Committee, 105 Amsden Road, Ormond Beach, FL 32176

By signing this application I am acknowledging that I have answered all of the questions truthfully and to the best of my ability.*

First Last

Today's Date*