Name of Church:
Name of Pastor:
How long with the Texas Southwest Jurisdiction:
Biographical Information
First Name
Last Name
Phone
Address
Street Address
Street Address Line 2
City
State / Province / Region
Postal / Zip Code
Country
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Austrian Empire*
Azerbaijan
Baden*
Bahamas, The
Bahrain
Bangladesh
Barbados
Bavaria*
Belarus
Belgium
Belize
Benin (Dahomey)
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Brunswick and Lüneburg
Bulgaria
Burkina Faso (Upper Volta)
Burma
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands, The
Central African Republic
Central American Federation*
Chad
Chile
China
Colombia
Comoros
Congo Free State, The
Costa Rica
Cote d’Ivoire (Ivory Coast)
Croatia
Cuba
Cyprus
Czechia
Czechoslovakia
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Duchy of Parma, The*
East Germany (German Democratic Republic)*
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Federal Government of Germany (1848-49)*
Fiji
Finland
France
Gabon
Gambia, The
Georgia
Germany
Ghana
Grand Duchy of Tuscany, The*
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Hanover*
Hanseatic Republics*
Hawaii*
Hesse*
Holy See
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kingdom of Serbia/Yugoslavia*
Kiribati
Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Lew Chew (Loochoo)*
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mecklenburg-Schwerin*
Mecklenburg-Strelitz*
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Namibia
Nassau*
Nauru
Nepal
Netherlands, The
New Zealand
Nicaragua
Niger
Nigeria
North German Confederation*
North German Union*
North Macedonia
Norway
Oldenburg*
Oman
Orange Free State*
Pakistan
Palau
Panama
Papal States*
Papua New Guinea
Paraguay
Peru
Philippines
Piedmont-Sardinia*
Poland
Portugal
Qatar
Republic of Genoa*
Republic of Korea (South Korea)
Republic of the Congo
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Schaumburg-Lippe*
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands, The
Somalia
South Africa
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Sweden
Switzerland
Syria
Tajikistan
Tanzania
Texas*
Thailand
Timor-Leste
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Two Sicilies*
Uganda
Ukraine
Union of Soviet Socialist Republics*
United Arab Emirates, The
United Kingdom, The
United States of America
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Württemberg*
Yemen
Zambia
Zimbabwe
Date of Birth:
Age:
E-mail Address:
Education
1. Name of current High School:
Campus Address
Street Address
Street Address Line 2
City
State / Province / Region
Postal / Zip Code
Country
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Austrian Empire*
Azerbaijan
Baden*
Bahamas, The
Bahrain
Bangladesh
Barbados
Bavaria*
Belarus
Belgium
Belize
Benin (Dahomey)
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Brunswick and Lüneburg
Bulgaria
Burkina Faso (Upper Volta)
Burma
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands, The
Central African Republic
Central American Federation*
Chad
Chile
China
Colombia
Comoros
Congo Free State, The
Costa Rica
Cote d’Ivoire (Ivory Coast)
Croatia
Cuba
Cyprus
Czechia
Czechoslovakia
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Duchy of Parma, The*
East Germany (German Democratic Republic)*
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Federal Government of Germany (1848-49)*
Fiji
Finland
France
Gabon
Gambia, The
Georgia
Germany
Ghana
Grand Duchy of Tuscany, The*
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Hanover*
Hanseatic Republics*
Hawaii*
Hesse*
Holy See
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kingdom of Serbia/Yugoslavia*
Kiribati
Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Lew Chew (Loochoo)*
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mecklenburg-Schwerin*
Mecklenburg-Strelitz*
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Namibia
Nassau*
Nauru
Nepal
Netherlands, The
New Zealand
Nicaragua
Niger
Nigeria
North German Confederation*
North German Union*
North Macedonia
Norway
Oldenburg*
Oman
Orange Free State*
Pakistan
Palau
Panama
Papal States*
Papua New Guinea
Paraguay
Peru
Philippines
Piedmont-Sardinia*
Poland
Portugal
Qatar
Republic of Genoa*
Republic of Korea (South Korea)
Republic of the Congo
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Schaumburg-Lippe*
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands, The
Somalia
South Africa
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Sweden
Switzerland
Syria
Tajikistan
Tanzania
Texas*
Thailand
Timor-Leste
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Two Sicilies*
Uganda
Ukraine
Union of Soviet Socialist Republics*
United Arab Emirates, The
United Kingdom, The
United States of America
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Württemberg*
Yemen
Zambia
Zimbabwe
GPA (on a 4.0 scale):
ACT Composite Score:
SAT Combined Score:
2. List any advanced or special programs, courses or summer courses you have taken. List the most recent course or program first:
3. Name of first-choice college or university:
City:
State:
4. What course of study(major) will you pursue? (You may indicate more than one. List in priority order.) 1st Choice:
2nd Choice:
3rd Choice:
If yes, specify:
Activities and Work Experience
1. List activities in which you have participated in your church at the local, district, state, and/or national level (such as Youth Department, Sunday School, Auxiliary In Ministries (AIM), Vacation Bible School). Place an X in front of those activities you consider most important.
Activity 1:
Activity 1 (Dates of participation):
Activity 1 (Hours per week):
Activity 1 (Office Held):
Activity 1 (Special awards or honors):
Activity 2:
Activity 2 (Dates of participation):
Activity 2 (Hours per week):
Activity 2 (Office Held):
Activity 2:(Special Honors or Awards)
Activity 3:
Activity 3 (Dates of participation):
Activity 3 (Hours per week):
Activity 3 (Office Held):
Activity 3:(Special Honors or Awards)
2. List activities in which you have participated in your school (such as academic, publications, debating, dramatics, sports, music, art, student government, and clubs) Place an X in front of those activities you consider most important.
School Activity 1:
School Activity 1 (Dates of participation):
School Activity 1 (Hours per week):
School Activity 1 (Office Held):
School Activity 2:
School Activity 2 (Dates of participation):
School Activity 2 (Hours per week):
School Activity 2 (Office Held):
School Activity 2:(Special Honors or Awards)
School Activity 3:
School Activity 3 (Dates of participation):
School Activity 3 (Hours per week):
School Activity 3 (Office Held):
3. List any special talents (such as music, art, or sports) that you pursue outside of school.
Talent or activity 1:
Periods of participation 1:
Special honors, recognition or awards 1:
Talent or activity 2:
Periods of participation 2:
Special honors, recognition or awards 2:
Talent or activity 3:
Periods of participation 3:
Special honors, recognition or awards 3:
4. List community activities in which you have participated without pay (such as religious work, drug hotlines, and/or outreach programs).
Kind of work 1:
Name of agency or organization 1:
Dates of participation 1:
Hours per week 1:
Special Awards 1:
Kind of work 2:
Name of agency or organization 2:
Dates of participation 2:
Hours per week 2:
Special Awards 2:
Kind of work 3:
Name of agency or organization 3:
Dates of participation 3:
Hours per week 3:
Special Awards 3:
5. List jobs (including summer employment) you have held in the past 3 years.
Job and kind of work 1:
Employer 1:
Enter in Box (summer/school year/both)1:
Approximate dates of employment 1:
Approximate # of hours per week 1:
Job and kind of work 2:
Employer 2:
Enter in Box (summer/school year/both) 2:
Approximate dates of employment 2:
Approximate # of hours per week 2:
Job and kind of work 3:
Employer 3:
Enter in Box (summer/school year/both) 3:
Approximate dates of employment 3:
Approximate # of hours per week 3:
Leisure-Time Activities
1. Describe your leadership role in activities in your church, school and community. What qualities of yours distinguish you as a leader?
2. Please describe any characteristics of yourself or your family that have been important to your personal development.
Candidate's Self Assessment
1. Describe a recent experience that has given you a sense of satisfaction or pride. Explain why you were satisfied or proud.
2. Briefly discuss the field of study you want to pursue in college and why.
Please review this form to make sure you have answered all questions completely. Proofread your responses. I certify that I completed this application and that all statements made are true and accurate to the best of my knowledge. (A false statement could eliminate me from consideration for this scholarship.)
Date:
First Name
Last Name
Narrative Essay
ESSAY TOPIC: “What personal traits do you possess that equips you for the intense college environment ahead?” Upload completed 300 to 400-word essay.
Upload Essay:
Please attach a copy of your transcript, including grades 9 through 12. If the transcript is not provided, you will be placed at a disadvantage in relations to other candidates.
Required Documents and Information
-Completed application form
-Contact information; phone #, email, address
-Completed school recommendation form
-School Transcripts
-Completed letter of recommendation from Pastor
-Confirm your church is in the TXSW Jurisdiction (Yes – No)
-Completed narrative essay of 300 words
Email graduation photos to ulabm5@gmail.com . Contact Missionary Ula Manor at 931-249-1025 if you have any questions.
Submit