TEXAS-LOUISIANA GULF COAST WOMEN OF THE EVANGELICAL LUTHERAN CHURCH IN AMERICA EDUCATION SCHOLARSHIP APPLICATION FORM GENERAL INFORMATION   You must be a member of an Evangelical Lutheran Church in America congregation. __________________________________________________   ___________________________________________ Name (Last) (First) (Middle Initial)   Name of ELCA Congregation __________________________________________________   ___________________________________________ Street Address Apt#   Street Address __________________________________________________   ___________________________________________ City, State, Zip   City, State, Zip __________________________________________________   Check if you wish ___ African American       ___ Asian American ___ Caucasian       ___ Hispanic ___ Native American/ American Indian Other _____________________________ E-mail           How many years since the completion of highschool? (Consecutive Years) _________________________ EDUCATION BACKGROUND: Lists schools attended, starting with high school.   Ages of dependent children ________________ __________________________________________________________________________________________________ Institution Diploma/Degree Year Degree Granted Dates Attended __________________________________________________________________________________________________ Institution Diploma/Degree Year Degree Granted Dates Attended __________________________________________________________________________________________________ Institution Diploma/Degree Year Degree Granted Dates Attended __________________________________________________________________________________________________ Institution Diploma/Degree Year Degree Granted Dates Attended PROFESSIONAL or OCCUPATIONAL BACKGROUND: Lists most recent position first. __________________________________________________________________________________________________ Employer Position Date (mo/yr) Reason for Leaving __________________________________________________________________________________________________ Employer Position Date (mo/yr) Reason for Leaving __________________________________________________________________________________________________ Employer Position Date (mo/yr) Reason for Leaving __________________________________________________________________________________________________ Employer Position Date (mo/yr) Reason for Leaving   PROPOSED PROGRAM:     __________________________________________________ Total cost of program $ __________________ Name of University or Institution     __________________________________________________ Amount requested from Women of the ELCA $ __________________ Street Address     __________________________________________________ Other funding sources   City, State, Zip ___________________ ___________________ ___________________ $ __________________ $ __________________ $ __________________ __________________________________________________ Program or Course of Study ___ Undergraduate        ___ Garduate        ___ Vocational Starting Date: ____________________________________     Expected Completion Date: __________________________     Have you previously received a Women of the ELCA Scholarship?       ____ Yes       ____ No   If yes, what scholarship (convention, triennial, etc.) _______________________________ Year(s)? _____________ Amount(s) $__________________     FINANCIAL INFORMATION: Please calculate all income and expenditure figures yearly, not monthly   Current Year Anticipated Household Income $________________ Expenditures $________________ Program cost (in detail). Please do not include these amounts in anticipated household expenditure amount above Tuition $ ___________________ Books $ ___________________ Supplies $ ___________________ Other $ ___________________ TOTAL $ ___________________ Please Read Carefully Applicant must provide: 1. Completed Application Form 2. Letters of Recommendation from tow of following: * Pastor of applicant's congregation * Women of the ELCA President of applicant's congregation * Executive Board Member (President, Vice-President, Secretary, Treasurer) of applicant's congregation 3. Transcript from most recent education institution 4. Essay describing chosen career path, goals, how course(s) will help applicant reach stated goals (not to exceed 1,000 words) PLEASE RETURN APPLICATION BY JULY 01, 2012 TO: Sheryl Holland, Treasurer Tx-La Gulf Coast Women of the ELCA P.O. Box 1852 Dickinson, Texas 77539