Anglican Church Worldwide (ACW)
Board of Education
Questionnaire
For College Scholarship
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1. Date of Application______________________________________
Name ___________________________________________________
Address_________________________________________________
Age of Applicant__________________________________________
Telephone Number ( )______________________________
E-mail___________________________________________________
Parents or Guardian Names:
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How long have you resided at your current address_____________________
2. If not a member of an Anglican Church, please supply 3 names of references along with telephone
numbers for verification.
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3. Did you graduate from High School (Yes)_______ (No)________
Please give the name of your graduated School
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4. Please give a 25 word hand written essay of why you should be considered for a scholarship.
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5. Please give a 25 word hand written essay of your educational goals.
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6. If accepted for Scholarship Funding, will you be a part time ( )
or fulltime ( ) student?
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7. What School do you plan to apply or attend?
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8. Is it your intention to complete this Scholarship to its completion should you be approved?
Yes ( ) No ( )
9. Please provide a transcript of you former School Record. This must be done before Scholarship is granted.
Addendum
What would you say is your best subject in High School________________________________________
What would you say is your most difficult subject in school_____________________________________
How well do you accept your teachers authority? Very well ( ) Sometimes ( ) Not at all ( )
Are you ready to accept full learning and discipline responsibility towards your education? Yes ( ) No ( )
Are there any legal issues or litigation (past or present) that will impede confirmation of your Scholarship?
(YES_________ ) (NO___________)
I ______________________________________________________ the undersigned verify that all information given in this (Printed Name of Student) document for scholarship requirements of the ACW Scholarship fund is true to the best of my ability.
Signed (Student)
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Mail to:
ACW Board of Education
National Chancery, Cathedral of the Good Shepherd
9301 Lebanon Road
Belleville, Illinois 62223 USA