FCA LEADERSHIP TRAINING SCHOLARSHIP FUND APPLICATION (due date – June 30) Thank you for completing this application. Please contact Valeria Dueck if you have any questions regarding your application. Telephone: (780) 663-2282 Name * First Last * Last Email * Home Phone Mobile Phone * Address * Address Line 2 City * Province * Postal Code * Country * Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Côte d'Ivoire Croatia (Hrvatska) Cuba Cyprus Czech Republic Congo (DRC) Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Islas Malvinas) Faroe Islands Fiji Islands Finland France French Guiana French Polynesia French Southern and Antarctic Lands Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong SAR Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao SAR Macedonia, Former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Yemen Zambia Zimbabwe Birthdate * Day/Month/Year S.I.N. Marital/Family Status * Single Married Divorced Separated Dependents? If you have dependent children, please indicate the number & ages FCA Home Church * How long have you attended? * Pastor’s Name & Phone # * Are you a committed Christian? * Yes No Uncertain Please Comment: * Education: * Employment Experience: * Current Occupation: * Church Involvement: * Community Involvement: * Plans to work in the Lord’s Harvest: * Please describe your call into Ministry, your plans at this point in time and your openness or commitment to working within the Fellowship of Christian Assemblies. Financial Information: * Please state the value of your assets, including cash, which are readily available to financing your education. Do you plan to work during the school year or to be a full time student? * Work Full Time Work Part Time Be a Full Time Student (not working during school year) Please Comment * Will family or friends financially support you during your schooling? * Yes No To what extent (dollar amount) will they support you? * Last Bible College/Seminary Year Completed: Name of Institution Date Completed: Day/Month/Year Grade Point Average: Proposed College or Seminary of choice for coming term: * Name of College or Seminary School Address: * School Phone Number * School Email Address * Please Upload proof of acceptance at the above named college: Drop a file here or click to upload Choose File Maximum upload size: 314.57MB I HAVE: * Read the description of the Scholarship Fund and believe that I meet the criteria for this application. Given a reference form to a leader in my home church who is connected to the FCA. Given a reference form to an acquaintance who knows me well. Attached proof of acceptance at the above named College. Reference forms available at: www.fcaministers.com/forms/canada reCAPTCHA For security purposes, please type both sets of characters in the box with a space between them. If the characters are hard to read click the refresh icon in the ReCaptcha box for new text.