Reading Moravian Church Scholarship Request Form
Personal Information
First Name:
*
Last Name:
*
Address:
*
City:
*
State:
*
Zip:
*
(xxxxx-xxxx)
Telephone:
*
(xxx.xxx.xxxx)
email:
*
(xxx.xxx.xxxx)
Date of Birth:
*
(YYYY-MM-DD)
Church Member?
Yes
No
Youth
Prior Scholarship Awards?
No
Yes Amount:
Prior Camp Awards?
No
Yes Amount:
Parent's / Sponsor's Information
Name:
*
Telephone:
*
(xxx.xxx.xxxx)
Higher Education School / Program
Name:
Address:
City:
State:
Zip:
(xxxxx-xxxx)
Telephone:
(xxx.xxx.xxxx)
Camp Hope, Hope NJ
Enrollment Date:
(MM/DD/YYYY)
Enrollment Cost:
Essay. Explain why you should receive the award.
* Required
Or, enter your reference number to check the status of your application:
