MEDIA Scholarship

"Let no corrupt communication proceed out of your mouth, but that which is good to the use of edifying, that it may minister grace unto the hearers". Ephesians 4:29 (KJV)

Name

First Name

Last Name

Date of Birth

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

U.S. or Caribbean National? (which country)?

Gender

Name of High School/Secondary School currently attending

School City/State

Name of High School/Secondary School Phone Number

G.P.A./Grade

Name of High School/Secondary School Counselor*

Extracurricular Activities

Leadership Positions Held

Work/Volunteer Experience

I declare that the essay is my own work, and that all the information is, to the best of my knowledge, accurate:

Yes

Today's Date

YYYY