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Semester Completion Statement Form

This form is required of those who have completed their Fall semester and intend to continue their enrollment for the next semester. It must be submitted by December 20th. (There is no Semester Completion Statement Form required after the Spring semester since all applicants are required to fill out a new scholarship application for the following year.)

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:
*10 + 1 =	Enter the correct answer to the math question.
Please click the Send button only once.

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