PLEASE NOTE PLEASE fill out ONLY ONE application form per year, even if you believe you qualify for more than one of our 13 scholarships. The same form is used to apply for all of our scholarships. The committee will match the best scholarship to each student. Date * For academic year: * Legal First Name: * Legal Middle Name: * Legal Last Name: * What name do you go by? * Country United States Canada Mailing address: * City: * State/Province Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Labrador Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick Newfoundland New Hampshire New Jersey New Mexico New York North Carolina North Dakota North West Territory Nova Scotia Nunavut Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Puerto Rico Quebec Rhode Island Saskatchewen South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, D.C. West Virginia Wisconsin Wyoming Yukon Postal Code: * Home or Cell number: Email address: * Date of birth: * Gender * Male Female Ethnic origin: * Have you ever received a scholarship from Disciples Home Missions? * Yes No If yes, what year(s) was/were scholarship(s) received? Please list your legal name when scholarship(s) was/were awarded. * Relationship status: * Single Married In committed life-long partnership Do you plan to be married within 12 months? * Yes No Will your spouse be a student? * Yes No Will your spouse's status as a student be "Full Time" or "Part Time"? * Part-time Full-time Where will your spouse be attending school? * (include name of school, and city and state where school is located) Will your partner be a student? * Yes No Will your partner's status as a student be "Full Time" or "Part Time"? * Part-time Full-time Where will your partner be attending school? * (include name of school, and city and state where school is located) Do you have children? * Yes No What are the ages of your children>? * Do you have any dependents other than children? * No Yes List all dependents other than children, and their relationship to you: * Name of school YOU will be attending this fall: * School mailing address: * Country United States Canada City: * State/Province Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Labrador Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick Newfoundland New Hampshire New Jersey New Mexico New York North Carolina North Dakota North West Territory Nova Scotia Nunavut Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Puerto Rico Quebec Rhode Island Saskatchewen South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, D.C. West Virginia Wisconsin Wyoming Yukon Postal code: * What year in seminary will you begin in the fall: * First year Second year Third year Fourth year or more Does not apply Please explain the reason for choosing "does not apply" above: Degree toward which you are working: * Projected date of completing degree: * Are you currently under care of a region of the Christian Church (Disciples of Christ)? * Yes No Name of region with which you are under care: * Name of regional minister with whom this information can be verified: * Email address of regional minister with whom this information can be verified: * If you are not presently under care, please explain your status of preparation for such: * Are you currently credentialed as: * Commissioned Ordained Other None If other, please specify: * Of which Disciples Region are you a member? General Commission on Ministry (GCOM) Christian Church in Alabama and Northwest Florida Christian Church in Arizona Christian Church of Northern California-Nevada Christian Church of the Pacific Southwest Christian Church in Canada Central Rocky Mountain Region Christian Church in Florida Christian Church in Georgia The Great River Region Christian Church South Idaho Christian Church in Illinois and Wisconsin Christian Church in Indiana Christian Church in the Upper Midwest Christian Church in Kansas Christian Church of Greater Kansas City Christian Church in Kentucky Christian Church Michigan Christian Church of Mid-America Christian Church in Montana Christian Church in Nebraska Christian Church - Northeastern Region Christian Church in North Carolina Christian Church in Ohio Christian Church in Oklahoma Christian Church in Oregon Christian Church in Pennsylvania Christian Church in South Carolina Christian Church in Tennessee Christian Church in the Southwest The Christian Church in Virginia The Northwest Regional Christian Church Christian Church Capital Area Christian Church in West Virginia Chaplains Office How long have you been a member of the Christian Church (Disciples of Christ)? * Home congregation's name: * City: * Country: * Abkhazia Afghanistan Aland Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Ascension Ashmore and Cartier Islands Australia Australian Antarctic Territory Austria Azerbaijan Bahamas Bahrain Baker Island Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Antarctic Territory British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Clipperton Island Cocos (Keeling) Islands Colombia Comoros Congo Congo (DRC) Cook Islands Coral Sea Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Islas Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern and Antarctic Lands Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Honduras Hong Kong Howland Island Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jarvis Island Jersey Johnston Atoll Jordan Kazakhstan Kenya Kingman Reef Kiribati Korea (North Korea) Korea (South Korea) Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Midway Islands Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar (Burma) Nagorno-Karabakh Namibia Nauru Navassa Island Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Cyprus Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territories (Gaza Strip and West Bank) Palmyra Atoll Panama Papua New Guinea Paraguay Peru Peter I Island Philippines Pitcairn Islands Poland Portugal Pridnestrovie (Transnistria) Puerto Rico Qatar Queen Maud Land Reunion Romania Ross Dependency Russia Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia Somaliland South Africa South Georgia and the South Sandwich Islands South Ossetia Spain Sri Lanka Sudan Suriname Svalbard Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste (East Timor) Togo Tokelau Tonga Trinidad and Tobago Tristan da Cunha Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu U.S. Virgin Islands Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Wake Island Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe State/Province Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Labrador Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick Newfoundland New Hampshire New Jersey New Mexico New York North Carolina North Dakota North West Territory Nova Scotia Nunavut Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Puerto Rico Quebec Rhode Island Saskatchewen South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, D.C. West Virginia Wisconsin Wyoming Yukon Postal code: * Name of current Pastor of your home congregation: * Pastor's Address: * City: * State/Province Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Labrador Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick Newfoundland New Hampshire New Jersey New Mexico New York North Carolina North Dakota North West Territory Nova Scotia Nunavut Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Puerto Rico Quebec Rhode Island Saskatchewen South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, D.C. West Virginia Wisconsin Wyoming Yukon Postal code: * Former congregation, if any: Denomination of former congregation: Name of former congregation's pastor: City of former congregation: Country of former congregation: Abkhazia Afghanistan Aland Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Ascension Ashmore and Cartier Islands Australia Australian Antarctic Territory Austria Azerbaijan Bahamas Bahrain Baker Island Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Antarctic Territory British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Clipperton Island Cocos (Keeling) Islands Colombia Comoros Congo Congo (DRC) Cook Islands Coral Sea Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Islas Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern and Antarctic Lands Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Honduras Hong Kong Howland Island Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jarvis Island Jersey Johnston Atoll Jordan Kazakhstan Kenya Kingman Reef Kiribati Korea (North Korea) Korea (South Korea) Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Midway Islands Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar (Burma) Nagorno-Karabakh Namibia Nauru Navassa Island Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Cyprus Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territories (Gaza Strip and West Bank) Palmyra Atoll Panama Papua New Guinea Paraguay Peru Peter I Island Philippines Pitcairn Islands Poland Portugal Pridnestrovie (Transnistria) Puerto Rico Qatar Queen Maud Land Reunion Romania Ross Dependency Russia Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia Somaliland South Africa South Georgia and the South Sandwich Islands South Ossetia Spain Sri Lanka Sudan Suriname Svalbard Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste (East Timor) Togo Tokelau Tonga Trinidad and Tobago Tristan da Cunha Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu U.S. Virgin Islands Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Wake Island Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe State/Province of former congregation Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Labrador Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick Newfoundland New Hampshire New Jersey New Mexico New York North Carolina North Dakota North West Territory Nova Scotia Nunavut Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Puerto Rico Quebec Rhode Island Saskatchewen South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, D.C. West Virginia Wisconsin Wyoming Yukon Postal code of former congregation: Transfer date (when you moved from former congregation to current congregation): If you left another denomination, why? Financial status: * Independent from parents Claimed as a dependent by parents Financial information (Please provide a short paragraph, of no more than 150 words, outlining your specific financial situation and describing any information that would be helpful to us in assessing your financial need): * 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 text below): * reCAPTCHA
Executive Minister for Christian Vocations (317) 713-2652
Ministry Associate (317) 713-2666