MOTHER MEMORIAL SCHOLARSHIP

Scholarship Information

Four $2,500.00 scholarships are available each year to an Indiana young person.

* Scholarships are only for a United Pentecostal Church International endorsed Bible College
* Student must live in Indiana and attend a United Pentecostal Church
* Application and references must be submitted by June 1st
* Scholarship will be paid directly to the college
* Student must plan to attend a full year (2 semesters)
* Scholarship can be awarded to a returning college student

Scholarships will be announced at Indiana Senior Camp or by email.

Name

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Address

Cell Phone

This address will receive a confirmation email

Date of Birth

Sex

Male Female

Marital Status Single Married Divorced Widowed

Parents or Guardian

Father (First & Last Name)

Father Occupation

Mother (First & Last Name)

Mother Occupation

Guardian (First & Last Name)

Guardian Occupation

Are your parents living:

Father Yes No

Mother Yes No

Marital Status of parents: Married Divorced Widowed

Do you live with your parents/guardian:

If there are other children living in the home, list their names and ages.

Child's Name:

Age:

Child's Name

Age:

Child's Name

Age:

Child's Name

Age:

SCHOLASTIC INFORMATION

Name(s) of College(s) attended

Address of College(s)

City

State

Zip Code

Name of most recent High School

Address of High School

City

State

Zip Code

GPA

Date graduated (or will graduate) from High School

List any scholastic honors you have received

List any school activities in which you have participated

EMPLOYMENT INFORMATION

Are you currently employed? Yes No

Full-time or Part-time Full-time Part-time

List below your most recent employment.

Employer

Address

Date Employed

Length of Employment

Position

HOUSEHOLD INCOME

Household Income Under $25,000 $25,000-$50,000 $50,000-$75,000 $75,000-$100,000 over $100,000

CHRISTIAN SERVICE INFORMATION

Have you received the baptism of the Holy Ghost according to Acts 2:4? Yes No

Date:

Place:

Have you been baptized in Jesus Name? Yes No

Date

Place

Are you now living a consistent Christian life to the best of your ability?

What church do you attend?

Name of current pastor:

Attended how long?

Pastor's address (street, city, state, zip code)

Home Phone:

Cell Phone:

List and describe any church related activities in which you have been or are now involved (youth, Sunday school, media, choir, evangelism):

Express in your own words why you want to attend Bible College and explain what contributions you believe a Christian education can make on your life and how you plan to utilize the benefits in the future. Approximately 400 words

Indicate below which endorsed Bible College of the United Pentecostal Church International you are interested in attending (check one only). Apostolic Bible Institute (St. Paul, Minnesota) Christian Life College (Stockton, California) Indiana Bible College (Indianapolis, Indiana) Texas Bible College (Lufkin, Texas) Northeast Christian College (Frederiction, New Brunswick) Urshan College (Wentzville, Missouri)

Do you feel a call to any particular area of ministry? Explain.

MOTHER MEMORIAL SCHOLARSHIP

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