General profile

Application date

/ /  (mm/dd/yy)

For academic fall

(year)

Name

Mailing address

City

State

   Postal code

Permanent address

City

State

   Postal code

E-mail

Phone

Date of birth

/ /   (mm/dd/yy)

Marital status

married single

If you are single, do you plan to be married within 12 months?
yes    no

If you have children, what are their ages?

Do you have other dependents? yes    no

If married, will your spouse be a student? yes   no

If yes:

full time? & part time?

Where?

Because of donor specifications, certain scholarships are awarded by gender, race or origin. To assist the committee, please indicate gender and race/ethnic origin:

Gender

female male

Race/ethnic origin

Educational profile

In what school do you plan to enroll for the next academic year?

School name

Mailing address

City

State

  Postal code

Classification

first year
second year
third year  

What degree do you anticipate upon graduation?

Degree

Projected date

/ /  (mm/dd/yy)

Religious profile

Eligibility for all DHM ministry-related scholarships require that students "be under care of a Regional Commission on the Ministry or in the process of coming under care."

Are you currently under care of a region of the Christian Church (Disciples of Christ):
yes no

Name or regional minister with whom we can verify this information:

If you are not presently under care, please explain:

(You might want to compose your text in a word processing program, then paste it into the text box below.)

Are you:

licensed
ordained
other

If other, please specify:

To which Disciples Region do you belong?

How long have you been a member of the Christian Church (Disciples of Christ)?

Home church

City

State

  Postal code

Pastor name

Address

City

State

   Postal code

Current church

(if different from home church)

Pastor name

City

State

   Postal code

If you recently became a member of the Christian Church (Disciples of Christ) please share the following:

Former church

Denomination

Pastor name

City

State

  Postal code

Transfer date

If you left another denomination, why?

(You might want to compose your text in a word processing program, then paste it into the text box below.)

Educational profile

Financial status:
claimed as a dependent by parents
independent from parents

1. Estimated total family annual income

2. Anticipated assistance

a. Scholarships

 b. Aid

 c. Other

3. Estimated annual expenses
  

  a. Housing (include utilities)

b. Medical & dental Medical

c. Child care & child support

  d. Tithe/charity

e. Miscellaneous

4. Estimated educational costs

  a. Tuition & fees

   b. Books

 c. Room & board
(if on campus)

Career goals

Describe briefly your call to ministry and planned vocational direction and goals (you might want to compose your text in a word processing program, then paste it in the box below):

References

The applicant is responsible for ensuring that five (5) references are sent to Disciples Home Missions staff by April 15. Referents can complete the form online by visiting this page: www.discipleshomemissions.org/Scholarships/reference.htm. Please send this address to your referents so they can complete the online form. Additionally, remind them of your deadline. There will be no exceptions regarding this deadline.

You also will need to let each referent know which "relationship to application" category they are meeting so they can select the appropriate category on their reference form. Each referent can only select one of these "relationship to applicant" radio buttons.

Please ask your referents to be specific in the matters of potential for ministry, of character, academic aptitude and relational skills. In order for full consideration of your application, references are needed from each of the following:

• Pastor of the congregation of which you are a member (unless spouse or family member; in which case ask another minister).
  
• Regional staff person (or Chair of Commission on Ministry); from Region/Area in which you are under care;
  
• Lay Leader in your congregation;
  
• Dean, professor or counselor of academic institution;
  
• Another person who knows you well, other than family member.

Transcript

Please make arrangements for Disciples Home Missions to receive an official transcript from your last completed semester in school by April 15. There will be on exceptions regarding this deadline.

Evaluation

a. Your application packet will be considered with all other applicants. Each portion of the application is considered and assigned a numerical value. If portions of your packet are missing, your application will be incomplete and will not be considered for any scholarship award. To be considered you must have a complete application packet.

b. It is important to check with your referents to ensure the timely submission of their letters.

c. It is the responsibility of the applicant to make sure all required documentation is submitted.

FOR YOUR INFORMATION APPLICANTS MUST APPLY AND OR REAPPLY EACH YEAR TO RECEIVE SCHOLARSHIPS. THERE ARE NO AUTOMATIC RENEWALS!!!

Please print a copy of this completed form BEFORE submitting in case there is a need to refer to it in the future.

Once you complete and print this form, you must submit it by clicking the "Submit application" button below. If you do not click the "Submit" button, the application will not be sent to DHM for consideration.