APPLICATION

JOURNEY TO THE CROSS SCHOLARSHIP

(Please print or type and use black ink)
STUDENT INFORMATION

DATE ____________________

Name _____________________________________________________________________________________
Permanent Address _________________________________________________________________________
City _________________________________________ State ___________________ Zip _________________
Date of Birth _____________________________ Home Telephone (
Cell Phone (

) ______________________________

) _________________________ Email Address _____________________________________

Member of ________________________________________________________________________________
(Name of Church)

City _____________________________ State __________ Pastors Name _____________________________

Activities, Organizations and Awards
List and/or describe the activities and organizations you have actively participated in during the past three
years. In addition, please include any awards that you have received. (Use an additional sheet if needed.)
A. School ______________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
B. Church ______________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
C. Community __________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

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What educational program or college major do you plan to enroll in? ________________________________
Expected completion date __________________________________
Name and location of institution you are or will be attending ________________________________________

FINANCIAL / EDUCATIONAL RESOURCES:

Are you presently employed? ______ Will you be employed while in school? ______
Number of persons residing in your household ____

Fill in the blanks to indicate the amount of financial assistance you will receive from other resources while in
school. Please indicate whether annual or monthly by circling A for annual or M for monthly.
Amt. $ _____________ A/M Current Salary (if applicable)
Amt. $ _____________ A/M Scholarships
Amt. $ _____________ A/M Loans
Amt. $ _____________ A/M Other _____________________________________________________________
_____________________________________________________________
_____________________________________________________________

I certify that all of the information on this application is true and complete to the best of my knowledge. If
requested, I agree to provide proof of the information that I have provided on this form.
Applicants signature _____________________________________________ Date ____________________

DONT FORGET TO INCLUDE YOUR TYPE WRITTEN OR WORD PROCESSED 200-300 WORD ESSAY WITH THIS
APPLICATION.

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