Scholarship Application Form
for Enrichment Events
Scholarship Application Form
for Enrichment Events
FAMILY INFORMATION
Applicant Name:
Address (including city and zip):
Phone:
E-mail:
Fax:
Name of Your Church:
Your Pastor/Moderator's Name:
INFORMATION ABOUT THE ENRICHMENT EVENT
Enrichment Event Are You Planning to Attend:
Reason You Wish to Attend This Event:
Name of the Sponsoring Organization:
Date of the Event:
Cost of the event:
Date by which you need the money:
The check should be made out to:
Full address to which the check should be sent:
Have you received scholarship funds before? (If so, when?)
Your signature:
Date of signature:
Clerk of Session or Moderator's signature:
Date of Clerk of Session/Moderator signature:
Is your church willing to contribute scholarship funds for this event as well?Please return this form to:
Rev. Erin Cox-Holmes
Associate General Presbyter
Presbytery of Kiskiminetas
P.O. Box 339
Yatesboro, PA 16263
| For office use only: Amount granted: $ Approved by: Date: |