Dr. William E. Flippin, Sr. Leadership Award
Please complete this form in its entirety. Thank you very much.
Rev. Dr. William E. Flippin, Sr., Senior Pastor
Date
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First Name
Middle Name
Last Name
Age
Date of Birth
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Address
Home Telephone
Cell Telephone
Email Address
Parent(s)/Guardian(s) Name
Parent(s)/Guardian(s) Telephone Number
Are you a members of The Greater Piney Grove Baptist Church?
If yes, how long have you been a member?
Membership Number
Participation/Leadership
The following requires participation verification on organization letterhead indicating leadership position, date of service and sponsor(s) signature. Without the signed verification letter(s) the application will be considered incomplete.
List the names of all school/community organizations you are a member of and the office(s) you have held in the space provided.
List all retreats/conventions/conferences you have attended where you represented the church.
Leadership (Church/School/Community): Please list the leadership positions you have held at church, school or in the community.
Upload Verification Documents
Upload Essay
What biblical figure would you emulate to positively influence and lead others? Describe the personal characteristics involved and why each is important (Minimum 500 words typed doubled spaced).
By checking both boxes below (applicant and parent), you are indicating that this application has been completing accurately and in its entirety.
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