NMI Scholarship Application
Please complete all sections
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Type of Application *
Please choose one
Name *
Please enter your full name. (First, Middle & last name)
Home Address (Full Home Address) *
Phone number *
Email *
Age *
Birthdate *
MM
/
DD
/
YYYY
Local Church *
Please enter the full Church Name & Location
College/University you attend (if applicable) *
Type of Participation *
Work & Witness Trip Information
Please enter the trip's and contact person's information.
Work and Witness trips are registered.  Please check with the coordinator and indicate here whether your trip is registered or not. *
If the Work and Witness trip is not registered, please describe what kind of trip it is.
Date of trip *
MM
/
DD
/
YYYY
Cost of trip *
Destination *
Type of Ministry *
Required
Trip Coordinator's Name *
Contact Person's name
Trip Coordinator's Email address *
Trip Coordinator's Phone Number *
Experience
Give a one-paragraph statement telling what you want to gain from this experience. *
Pastoral Reference
Please provide your Pastor's Name and Email Address.

An email with a referral request will be emailed to your pastor. Please let him or her know that they will need to complete the referral process in order for your application to be considered complete.
Pastor's Name *
Pastor's Full Name
Pastor's Email Address *
Pastor's Phone Number *
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