Name: Age:
Email Address:
Home Address:
Name of school presently attending (or last attended):
Parent or Guardian Names:
Name and Address of School you plan to attend:
Date you plan to begin:
What course do you intend to pursue?:
You are a member of what Church?:
List all Church activities in which you have taken part, including any offices you may have held:
Please submit a letter of recommendation from your principal or superintendent and a transcript of the latest year's grades.
A personal interview with the scholarship committee may be required. If so, you will be notified.
Submit additional requested information to the Chairman of the Scholarship Committee no later than April 30th on the year the application is made. Chairman information is as follows:
Gary Forristall
12173 350th St
Macedonia, IA 51549
Or, send scanned documents to pastorbrucesmith@gmail.com
