AGBU RELIGIOUS EDUCATION ASSISTANCE PROGRAM APPLICANT CONTACT INFORMATION Name: Home Address: City:
State:
Zip:
Home Ph#:
Business Ph#:
Mobile Ph#:
Name of Parish: Position/Title: Date of Hire: Primate/Prelate or Parish Priest (They must approve this request):
EDUCATIONAL INFORMATION Highest Degree Earned:
Year:
Name of School/Institution:
Major/Field of Study:
Answer the questions below as they pertain to the course(s)/program of study for which you are requesting educational assistance. Title of Course/Program of Study: Name of School/Institution:
Semester:
Spring
Summer
Fall
Winter
Year:
Description of Course/Program of Study:
Course/Semester Start Date:
Course/Semester End Date:
Total Tuition/Fee: $
Applicant: _________________________________
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AGBU RELIGIOUS EDUCATION ASSISTANCE PROGRAM Describe below how this course(s)/program of study will serve to maintain or enhance your role within the church. Please be as specific as you can.
Applicant: _________________________________
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AGBU RELIGIOUS EDUCATION ASSISTANCE PROGRAM
TERMS & CONDITIONS •
Education Assistance is available to clergy and lay leaders pursuing a professional development course/workshop/training(s)/certification.
•
Assistance is available for a maximum of $1,500 per semester.
•
Upon successful completion of the subject course(s)/semester, you must submit a letter describing what you learned and its application to new or improved practices at your parish.
Applicant Signature: ___________________________________________ Date: ___________
Submit this form, completed & signed, along with the materials listed below, to: AGBU EDUCATION 55 EAST 59TH STREET, 7TH FLOOR NEW YORK, NY 10022 OR TO
[email protected] The following documents must be submitted along with the AGBU Religious Education Assistance Program application: ¾ Course description(s) from course catalog ¾ Tuition fee schedule ¾ Enrollment verification, registration confirmation or acceptance letter ¾ Letter of Support from Primate/Prelate or Parish Priest Questions? Email
[email protected] or call (212) 319-6383 ext.124.
Applicant: _________________________________
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