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Name*
Phone*( ) -
Email*
, AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
Parent or Guadian's Names*
School or College you expect to attend or are enrolled in*
Field of Study*
Please list any church activities you have participated in this past year*
(Summer 2021 to present)
Please list school and community clubs and organizations you have participated in*
Please explain how you will use the monies to further your education*
Please submit the requested information us no later than May 29th
