Atkinson Scholarship Application

Full Name

Date of Birth

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email

Phone

Member of Collierville UMC?

Yes

No

If “NO”, name of United Methodist Church where you are a member:

Marital Status

Number of Dependents

Education

Undergraduate Degree(s) School:

Degree Received

From Date Attended

To Date Attended

Would you like to add another Undergraduate Degree School

Yes

No

Undergraduate Degree(s) School:

Degree Received

From Date Attended

To Date Attended

Master’s Program For Which You Are Applying

Seminary Name (Do Not Abbreviate):

Major/Course of Study:

What degree is being sought?

Registration dates

Fall Term:

Spring Term:

Expected Graduation Date:

Finances - Income

Salary (self):

Salary (spouse):

School Loans:

Scholarships:

Other Income:

Other Income #2:

Other Income #3:

Total Income:

Finances - Liabilities / Expenses

Rent/Mortgage:

Utilities:

Phone:

Transportation:

Food / Groceries:

Loans:

Other Expenses:

Other Expenses #2:

Other Expenses #3:

Total Expenses:

FINANCES - FUTURE

Tuition Cost Per Semester Fall:

Tuition Cost Per Spring Fall:

Anticipated Scholarship Funding

Per Semester or Per Year?

Per Semester

Per Year

TWKUMC MEF:

Other Grants:

Loans:

Other Funding:

Other Funding #2:

Total Future Expenses

Requested 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.

Signature

Date

Atkinson Scholarship Application - BrownBear IT

Atkinson Seminary Scholarship

Education

Master’s Program For Which You Are Applying

Registration dates

Finances - Income

Finances - Liabilities / Expenses

FINANCES - FUTURE

Requested Financial Aid (Year)

Certification