Lutheran Share The Word Teens Encounter Christ

(Eastern North Carolina)

Scholarship Application

Circle the date of the TEC weekend for which you are requesting financial assistance.

	2010	2011	Youth___ Adult___ (21 or older)
Martin Luther King		#41 (1/15-17)
Labor Day	#40 (9/4-6)	#42 (9/3-5)	Today's Date____/____/______

Name____________________________________________ Male_____ Female_____ Date of Birth____ /____ /_______

High school student: Freshman____ Sophomore____ Junior_____ Senior____ College Student_____ N/A______

Address______________________________________________________________________ Age ___________________

City________________________________ State______ Zip__________ E-Mail _________________________________

Phone (_____ ) ______ - ___________ School_____________________________________________________________

Church Name______________________________________ Pastor(s) ___________________________________________

Parent Or Guardian's Name(s)_____________________________________________________________________________

The total cost of the weekend is $150.

Amount you can pay _____________________________________________________________________________

Amount your church will pay _______________________________________________________________________

Amount requested for scholarship __________________________________________________________________

Reason for assistance ___________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

Signature of Guest _____________________________________________________ Date: __________________________

Signature of Parent ____________________________________________________ Date: __________________________

Signature of Pastor ____________________________________________________ Date: __________________________

You will be notified by a Share the Word TEC Board member with the status of your request prior to the retreat weekend.

Please mail completed forms to:

Share the Word T.E.C. - Scholarship

c/o Grace Lutheran Church

5010 Six Forks Road

Raleigh, NC 27609

Scholarship applications MUST be received at least two weeks before the weekend.

Revision date: February 2010