Richard B. Gibbins Post-Secondary Scholarship Application Form

The Old Greenwich Presbyterian Church Board of Deacons

The purpose of the Reverend Richard B. Gibbins Scholarship is to provide financial assistance to individuals who are members of Old Greenwich Presbyterian Church and who demonstrate financial need. This scholarship will be primarily for church youth who are accepted to a college, university, trade school or other post-secondary institute.

Contact the deacons at ogpcdeacons@gmail.com - Application due by MAY 12th

Post-Secondary Scholarship

scholarship application for Post Secondary Education

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone(Required)

Email(Required)

Name of program you wish to attend:(Required)

School/Organization offering program:(Required)

Brief description of program:

Cost of program:(Required)

Amount you are requesting toward the income:(Required)

Have you applied for or received financial assistance for this program from another source?(Required)

Yes

No

If so, what is the amount your have requested:

What amount did you receive?:

The following questions are to be completed by the applicant:

Please describe briefly why you qualify for the need-based scholarship:(Required)

What is your most recent involvement with OGPC, including any offices that you have held or activities that you have participated in?(Required)

Signatures

If the applicant is a minor, both signatures are required

Aplicant Signature

Date

MM slash DD slash YYYY

Parent/Guardian Signature

Date

MM slash DD slash YYYY