scholarship request form

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SCHOLARSHIP REQUEST FORM LINCOLN PRESBYTERIAN STUDENT MINISTRIES 2015 Today's Date

Name of Event Event Date The ministry in which the event is taking place (Please check one)

□ JUNIOR HIGH

□ HIGH SCHOOL

Student Information: ·

Name

·

Phone

·

Address

LPC's Total Cost for Event $ Amount of family contribution

$

LPC Use Only

Requested Scholarship Amount

$

$ Approved by:

Family Financial Status:

(Give as much information as available)

Parents Marital Status

□ SINGLE

□ MARRIED

Number of Children in the family # * Family's approximate monthly income

□ DIVORCED

. $

.

*This information must be completed for campership to be considered. Unusual Expenses: . Please give reason(s) for eligibility: .

Signature of Parent:

NOTE: You must submit a separate request form for each event you would like a scholarship for