Scholarship Form printable pdf download

Scholarship Form

Steubenville St. Louis Mid-America 2017

Scholarship Form

Group Leader Name:_________________________________________________________________________

Group Leader Email:_________________________________________________________________________

Group:____________________________________________________________________________________

Week Attending (circle one)

Week 1 – July 14-15-16

Week 2 – July 21-22-23

Teen Name:

_____________ Age of Applicant:______________

Teen applying for scholarship funds

Current Grade in High School

Amount of Scholarship needed

(Scholarships will be awarded on availability of funds)

Please describe the financial need for the scholarship. Please be specific.

______

___________________

____________________________________________________________________________________

__________________________________________________________________________________________

Parent/Guardian Signature

Group Leader Signature

Scholarship Applications are due by March 13, 2017

Applicants will be notified of scholarship on March 27, 2017

Mail to:

For office use only

STEUBENVILLE SCHOLARSHIPS

Date received:

Tom Lancia

20 Archbishop May Drive

Amount requested:

St. Louis, MO 63119

Amount rewarded:

Scholarship Form