APPLICATION FOR SCHOLARSHIP. HETTY JACKSON / DR. MARTIN LEWIS SCHOLARSHIP FUND PASS-A-GRILLE BEACH COMMUNITY CHURCH United Church of Christ The application is for post high school education. Priority will be given to undergraduate college, technical and vocational students. Funds will be paid directly to the school. Submit this application along with two letters of recommendation from members of Pass-A-Grille Beach Community Church to the church office. Name: Telephone: Address: Date you joined Pass-A-Grille Beach Community Church Month/Year of high school graduation: or GEI What school do you plan to attend: Address of school: City, State, Zip: Phone Number of schot Date you plan to begin studies:. Have you applied to above school? ©) yes) no If so, have you been accepted? () yes () no If accepted, your student identification number assigned by the school: Are you planning tobe a: (~) fulltime or ©) part-time student? Your major will be:, Your degree or diploma upon completion will be: Since high school graduation have you graduated or received a diploma from a college, university, technical, or vocational school: ©) yes One If yes, please specify: Have you received a scholarship from Pass-A-Grille Beach Community Church in the past? ()yes () no If yes, date and amount received: List any special awards and/or honors that you have received in school or form other sources: