Atkinson Seminary Scholarship Step 1 of 3 33% Full NameDate of Birth MM slash DD slash YYYY Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email PhoneMember of Collierville UMC? Yes No If “NO”, name of United Methodist Church where you are a member:Marital StatusMarriedNot MarriedCommon Law MarriedWidowedSeparatedDivorcedNumber of Dependents EducationUndergraduate Degree(s) School:Degree ReceivedFrom Date Attended MM slash DD slash YYYY To Date Attended MM slash DD slash YYYY Would you like to add another Undergraduate Degree School Yes No Undergraduate Degree(s) School:Degree ReceivedFrom Date Attended MM slash DD slash YYYY To Date Attended MM slash DD slash YYYY Master’s Program For Which You Are ApplyingSeminary Name (Do Not Abbreviate):Major/Course of Study:What degree is being sought?Registration datesFall Term: MM slash DD slash YYYY Spring Term: MM slash DD slash YYYY Expected Graduation Date: MM slash DD slash YYYY Finances - IncomeSalary (self):Salary (spouse):School Loans:Scholarships:Other Income:Other Income #2:Other Income #3:Total Income:Finances - Liabilities / ExpensesRent/Mortgage:Utilities:Phone:Transportation:Food / Groceries:Loans:Other Expenses:Other Expenses #2:Other Expenses #3:Total Expenses:FINANCES - FUTURETuition Cost Per Semester Fall:Tuition Cost Per Spring Fall:Anticipated Scholarship FundingPer Semester or Per Year? Per Semester Per Year TWKUMC MEF:Other Grants:Loans:Other Funding:Other Funding #2:Total Future ExpensesRequested Financial Aid (Year)Tuition:Books:Other Fees:Other Expenses:Other Expenses #2:Other Expenses #3:Total Expenses:Certification I certify, to the best of my knowledge, that the information on this application is complete and accurate. Falsification of any information will cause my disqualification from the scholarship competition. I understand it is my responsibility to make sure this application is completed by the deadline listed on the application. Furthermore, I understand that if my application is not complete, I may be disqualified from the scholarship competition and may not be considered for a scholarship. I fully understand the conditions of this scholarship.SignatureDate MM slash DD slash YYYY