Application Form - 2016 Summer Camp Scholarship (Agape Leaders)

Scholarship Application Form

Scholarship application submission begins on April 25th 2016 and ends on May 27th, 2016.
Read and follow the instructions carefully prior to submitting your application.

If selected, you will be asked for documentation to support the data you provide. Likewise, all correspondence and award agreements will be generated from the personal information submitted below. So, please use proper spelling, capitalization and punctuation.
I. Personal Data:

Tell us about yourself
Student's Name*

First NameLast Name
Birthdate:*

MonthDayYear
Parent's Name*

First NameLast Name
E-mail*
Phone Number*

Area CodePhone Number
Home Address :*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
II. School Information:
School Name:*
City:
State:
Grade (2016-2017)*
III. Essay
Please have your child finish the following paragraph:

I would like to participate in the Agape Leaders Institute Summer Camp for 1 week because:
Essay:*

0/500
IV. Parent's Financial Information
2015 Annual Income*

Less than $35,000 (Full Scholarship)Less than $45,000 (Partial Scholarship)
If selected, you will be asked for documentation to support the data you provide.
V. Select The Program
Choose The Location
Location*
Choose The Best Week:
1st Choice*
2nd Choice
3rd Choice
By signing (typing your legal name) in the space below, you are certifying that all information is correct and that you are the person completing this application. When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your application.
E-Signature:*
Enter the message as it's shown*
Should be Empty:

Scholarship Application Form

I. Personal Data:

II. School Information:

III. Essay

IV. Parent's Financial Information

V. Select The Program