Southwest Region Conference Union Scholarship Application

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1 TO: RE: Scholarship Applicant Southwest Region Scholarship Application Enclosed please find the Southwest Region Conference Scholarship Application Form. Read the information carefully before completing this form. Before you proceed to read the instructions and complete the application form, answer the following questions: 1. Full Time Student at Southwestern Adventist University/Oakwood University Undergraduate Studies ONLY: Are you a full-time undergraduate student currently enrolled in Southwestern or Oakwood in a program leading to a Bachelor degree? Yes No 2. Membership: Are you a member in good and regular standing with membership in the Southwest Region Conference? Yes No 3. Institution: The college/university that I am attending is within the United States. Yes No 4. Employment of Parent(s) Is your parent(s) employee(s) of Southwest Region Conference? Yes No If you answered NO to any of the above questions, you are ineligible to receive the Southwest Region Conference Union Scholarship. INSTRUCTIONS Please read carefully the enclosed information and instruction. Completing all forms and obtaining the original signatures and financial records are essential to the application process. The application form must be requested from the Southwest Region Conference Office of Education. No faxes or copies accepted only originals. A student can only apply for this scholarship ONCE a year and must have successfully completed ONE semester prior to receipt of this scholarship. Funds will be posted to your account during the semester. Therefore, it is your responsibility to ensure that proper arrangements are made at the beginning of the semester. The applicant must submit verification of financial need based on information included in the application, and must be earning satisfactory grades. The application form needs to be completed and send to the Southwest Region Conference Office of Education. Applications received after the deadline will not be processed. Deadline: Fall Semester: July 31 Spring Semester: December 1

2 FAMILY STATUS: NAME: AGE: SS# STREET ADDRESS CITY: STATE: ZIP: HOME NUMBER: CELL: ADDRESS WHILE AT SCHOOL: MARTIAL STATUS: SINGLE DIVORCED MARRIED SEPARATED: SPOUSE S NAME: NUMBER OF CHILDREN: AGES: _ CITIZENSHIP: EDUCATIONAL STATUS: NAME OF HIGH SCHOOL: _ GRADUATION YEAR: NAME OF COLLEGE/UNIVERSITY ATTENDING: _ DATE STARTED: ADDRESS: STREET CITY STATE ZIP DEGREE SOUGHT: _MAJOR AREA OF STUDIES: CLASSIFICATION: FRESHMAN SOPHOMORE JUNIOR SENIOR SCHOLARSHIP IS REQUESTED FOR WHICH SCHOOL TERM: SEMESTER: YEAR: 20 WHICH SEMESTER DID YOU RECEIVED YOUR LAST SCHOLARSHIP: SEMESTER: YEAR: 20 WHAT WAS THE VALUE OF THE SCHOLARSHIP RECEIVED: $

3 FINANCES: Please attached an original print out from the financial aid department of your institution that reflects your payment and balances of the prior semester that you were in school. (REQUIRED DOCUMENT) Applications will not be processed without the correct documentation. Please submit supporting documentation CURRENT MONTHLY BUDGET (Please calculate the figures below on a monthly basis). MONTHLY INCOME Savings & Checking Accts. Aid: (Parent(s) Guardian (s) Applicant s Income MONTHLY EXPENSE *Tuition Fees Insurance Spouse s Income Sub Total - Monthly $ GI Benefits Work Study Assistance Other Income From: Tithe & Offerings Food Lodging Sub-Total Monthly $ Creditor Bal: Grants Creditor Bal: Loans Scholarships Sub-Total Monthly $ Sub-Total Monthly $ Grand Total - Monthly $ Grand Total Monthly $ If your tuition expense is on a quarterly basis, multiply the amount by 4, and then divide the total into 12, that would be your monthly expense. For example, if you pay a quarter for tuition, multiply x 4 = 3,332/12 = (this would be your monthly expense). If your tuition fee is every 10 months, divide the amount into 10, the total is your monthly expense.

4 SIGNATURES: ONLY SIGNATURES FROM THE APPLICANT AND THE LOCAL PASTOR ARE ACCEPTABLE. APPLICATIONS WITH AUTHORIZED SIGNATURE FROM THE PASTOR OR STUDENT BEHALF WILL BE DISQUALIFIED. APPLICANT: Affirmation: (Print Name) I, hereby state that the information given on this application is to the best of my knowledge true and accurate. I hereby indicate my loyalty to the principles of the Seventh day Adventist Church and my commitment to its objectives. It is my plan to support the cause of God through the use of my training. Date: Signature: Applicant CHURCH: The _SDA church of approves the applicant as a member in regular standing and worthy of the scholarship grant requested. Pastor s Phone Number: (Day): (Evening): _ Print Name: Date: _ Signature: Pastor LOCAL CONFERENCE: The SOUTHWEST REGION CONFERENCE approves the applicant worthy of the Southwest Region Conference Union Scholarship. Signature: Date:

5 The Southwest Region Conference denies this scholarship request for the following reason (s): Incomplete application Applicant is not a Seventh-day Adventist Late application (Funds depleted for the year) Authenticity of signature College/University is ineligible Missing financial records Other _ Signature: _ Date:

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