SCHOLARSHIP APPLICATION FORM

COMPLETE AND MAIL TO:

Southeast Region Administrative Offices .............................Phone: 304-345-9347
1211 Dudley Road, ...........................................................FAX 304-345-0948
Charleston, WV 25314 .....................................................E-mail: SEUnity@charter.net

Note: Scholarships are available on the basis of one per ministry or individual every other year. Any ministry, minister, spiritual leader or licensed teacher receiving a scholarship to any training is not eligible for a scholarship to a different training within that two year period. Registration form & fee for the event must accompany this application. You will be reimbursed once the scholarship has been approved . Scholarships are awarded to ministers and spiritual leaders only.

The intent of the scholarship program is to support, not enable. It is important that the individual Ministries build prosperity consciousness that allows funding for church leaders to participate in continuing education programs and activities vital to their spiritual and professional growth.

(Please Print)
Name:________________________________________________________________________

Address:______________________________________________________________________

Phone: (H)___________________(W)___________________(E-mail)_____________________

Name of Church:________________________________________________________________

Church Address:_________________________City_____________________State_____Zip______

Church Phone:___________________________(E-mail)________________________________

The last scholarship received by our ministry was (Date)_________for (Event)_________________

We hereby apply for a scholarship for:

Name:_________________________________Title:_______________________________

To attend: Annual Regional Conference: Dates ________________________
Peaceworker Training: Dates:_____________________________
Other: Title & Dates:____________________________________

I will be unable to attend this event without a scholarship: Yes_____ No _______

Minister's Signature _____________________________________
Date:_______________________________

Board President's Signature _______________________________
Date:_________________________________

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For Office use only:

Scholarship: Date request Received:___________ Approved:_______Not Approved:________

Notification sent:_______________

Refund reimbursed: Check #___________Amount $_______________ Date:________________