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DHM Scholarship Application

Home » Vocational Support » Student Scholarship Program » DHM Scholarship Application

DHM Scholarship Application

PLEASE NOTE

Date

For academic year: *

Legal First Name: *

Legal Middle Name: *

Legal Last Name: *

What name do you go by? *

Country

Mailing address: *

City: *

State/Province *

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

City: *

State/Province *

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?

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

Home congregation’s name: *

City: *

Country *

State/Province *

Postal code: *

Name of current Pastor of your home congregation: *

Pastor’s Address: *

City: *

State/Province *

Postal code: *

Former congregation, if any:

Denomination of former congregation:

Name of former congregation’s pastor:

City of former congregation:

Country of former congregation:

Country of former Congregation:

State/Province

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): *

Captcha

If you are human, leave this field blank.

Contact

Kelly Harris, Ministry Associate, Office of Christian Vocations

Email: kharris dhm.disciples.org

Phone: (317) 713-2666

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Contact

P.O. Box 1986
Indianapolis, Indiana 46206
info@dhm.disciples.org

We are a general ministry of the Christian Church (Disciples of Christ).
We are supported in part by Disciples Mission Fund giving.

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