INTERNATIONAL WOMEN LEADERS Scholarship Profile

Transcription

1 Global Mission International Leadership Development Program INTERNATIONAL WOMEN LEADERS Scholarship Profile NOTE: Scholarship profile deadline is October 15, PERSONAL INFORMATION Name: LAST NAME/SURNAME (AS APPEARS ON PASSPORT/BIRTH CERTIFICATE) FIRST NAME/GIVEN NAME (AS APPEARS ON PASSPORT/BIRTH CERTIFICATE) OTHER NAME(S) TITLE (REV/DR/MRS/MS/MISS/OTHER PLEASE SPECIFY) Birth Marital Status (Check one): Married Single Address: STREET ADDRESS CITY/TOWN ---- STATE/PROVINCE POSTAL CODE COUNTRY Cell Phone (Mobile): Gender: EDUCATIONAL INFORMATION Has applicant ever received an ELCA scholarship/grant before? If yes, describe program that was funded. Yes No MM/YYYY 1

2 Potential area of study/academic interests (please check all that apply): (Note: This is not an exhaustive list of possible areas of study. Future communication will provide a more complete selection of majors/minors.) Accounting Chinese Studies English International Studies Physics Africana Studies Church Leadership English Literature Italian Studies Political Science American Studies Classics Entrepreneurship Japanese Studies Psychology Anthropology Communication Environmental Science Management Public Policy Art Computer Science Exercise Science Marketing Religion Art History Creative Writing Film Mathematics Russian Studies Art Therapy Criminology Finance Metro-Urban Studies Social Work Athletic Training Cross Cultural Studies French Music Sociology Biblical Languages Dance Geology Music Education Spanish Biochemistry/ Molecular Biology Biology Earth Sciences German Music Performance Sport Management East Asian Studies Globalization Studies Norwegian Theater Biopsychology Economics Graphic Design Organizational Women and Leadership Gender Studies Business Education Health Sciences Nursing Worship Ministries Chemistry Engineering History Philosophy Youth Ministry and Christian Education If your desired area of study is not listed above, please provide a brief description of your academic interests: Proposed place of study (optional): Augsburg College Capital University Gettysburg College Luther College Newberry College Wittenberg University Have you taken the TOEFL (Test of English as a Foreign Language)? Yes No If yes, please enter score here: Have you taken the SAT test? Yes No If yes, please enter scores here: CRITICAL READING Language Proficiency: MATHEMATICS WRITING LANGUAGE 1 LANGUAGE 2 LANGUAGE 3 LANGUAGE 4 2

3 Are you currently enrolled in school? Yes No Please provide the following information about your current or most recent school: School Name: School Location: CITY, STATE/PROVINCE, COUNTRY Dates of Enrollment: START DATE (MM/YYYY) COMPLETION DATE (MM/YYYY) Degree/Certificate/Diploma Earned (or in progress): Please list the courses/subjects which you are currently taking or which you most recently took: NAME OF COURSE 1 NAME OF COURSE 2 NAME OF COURSE 3 NAME OF COURSE 4 NAME OF COURSE 5 NAME OF COURSE 6 Please list any activities (arts, athletics, clubs, personal commitments, community groups, etc.) in which you participate: If you are currently employed or were previously employed, please list your work experience: Signature of Applicant:

4 3. SCHOLARSHIP ENDORSEMENT To be completed by authorized church official. 1. What are the plans and goals for this applicant in your church, and how will the applicant s study benefit the church? 2. Has the applicant been approved by the appropriate church committee or board? Yes No If yes, name of committee: Authorized home church/institution endorsement name and signature: Signature: Name (please print): Position/Title in the Church: On behalf of: Church: Address: STREET ADDRESS CITY/TOWN --- STATE/PROVINCE -- POSTAL CODE --- COUNTRY Phone: Fax:

5 4. Additional comments: RETURN INFORMATION Please send completed scholarship profile by October 15, 2015 to: By post: By By fax: Director for International Leadership Development Evangelical Lutheran Church in America Global Mission 8765 West Higgins Road Chicago, IL United States of America (Attn. Director for International Leadership Development) If you are in need of assistance or more information, please contact us: Phone: Fax: