Application for the Surrell Scholarship
Central Presbyterian Church Terre Haute, IN

Each question must be answered completely.

Applications must be returned via online or to the church office by April 22, 2019.

No applications will be received after this date!!

May email to cheryl@thcpc.org or fax 812-232-5040

Email address *
Full Name: *
Your answer
Age: *
Your answer
Address: *
Your answer
Phone: *
Your answer
Parents' Name(s): *
Your answer
Parents' Address: *
Your answer
How long have you been a member of, or regularly attended Central Presbyterian? *
Your answer
For what purposes would you spend any funds you might be awarded (tuition, fees, etc.) *
Your answer
In the space below, list the name, age, and college (if applicable) of any sibling still living in the household. Please list each sibling on a separate line. *
Your answer
List your first choice for college/university. *
Your answer
List your second choice for college/university. *
Your answer
List your third choice for college/university. *
Your answer
What is your (anticipated) area of study? *
Your answer
What are your anticipated costs for next year (tuition, room and board, books, supplies, etc.)? *
Your answer
*** Class of 2019 graduates: What is your class rank? (example: 5 of 234)
Your answer
***Class of 2019 graduates: What is your GPA?
Your answer
In 250 words or less, please describe your involvement with church based activities? *
Your answer
Give a brief statement describing your work history and monies saved for advanced education plans. *
Your answer
List each of your school activities on a separate line with the average number of hours per week you spend on them. Examples: clubs, sports, student government, music, drama *
Your answer
List each of your church activities on a separate line with the average number of hours per week you spend on them. Examples: Sunday school, youth group, etc. *
Your answer
List each of your community activities on a separate line with the average number of hours per week you spend on them. Examples: volunteer, sports, scouts, music, drama *
Your answer
List your work history. Please include employer, type of work, whether it is summer or school year employment, and the average number of hours worked per week. *
Your answer
List any leadership positions, awards, letters earned, recognition, etc. *
Your answer
This scholarship is based scholastic achievement and church based activities.
If this application is not fully completed with all requested documents, you will not be considered for a scholarship.
Please type your full name below as your signature. *
Your answer
Please type the date. *
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