Semester Completion Statement

The deadline for the Statement of Successful Completion of your first semester and intention to register for a second semester is December 20.

AFTER YOU SUBMIT THIS FORM, PLEASE CHECK YOUR EMAIL INBOX (THAT IS, THE EMAIL YOU LIST ON THIS FORM) FOR A CONFIRMATION EMAIL THAT YOUR STATEMENT OF SUCCESSFUL COMPLETION WAS RECEIVED.

* Required Fields

*Student Name:
*Primary mailing address:
*Email Address:
*Student phone #:
*Educational status:
*Name/Address of institution where scholarship will be used:
*In a paragraph, please state whether or not you have successfully completed your first semester and have registered for a second semester.:
I certify that all statements made on this application are true to the best of my knowledge and that I have attended a morning worship service at First Baptist Church, Wellsboro at least 75% of the time when I have been in the Wellsboro area.
*Signed (type name):
Remember to check your email for a confirmation message after you hit "SEND"!
*Authentication:
*0 + 4 =	Enter the correct answer to the math question.
Please click the Send button only once.