Christian Service Scholarship Program
Student Name
First
Middle
Last
Student ID #
Address
Street Address
City
State
ZIp Code
Parent/Minister Name
First
Middle
Last
Church Name
Phone
Church Address
Street Address
Address Line 2
City
State
ZIP Code
Job Title
Job Responsibilities
Is Parent the Senior Minister?
Yes
No
Who is your Ministry Employer?
Student Signature
Date
MM slash DD slash YYYY
Parent Signature
Date
MM slash DD slash YYYY
Senior Minister Signature
Date
MM slash DD slash YYYY
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