Young Presbyterian Scholars Program Nomination Form

Student Information

Title:

Legal First Name

Middle Name

Legal Last Name

Suffix:

Preferred Nick Name

Birthdate (if known)

Student Email

Cell Phone Number

Home Phone Number

Mailing Address

Country

Street

City

Region

Postal Code

School Name:

Student GPA (Cumulative)

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Church Information

Church

Email

Phone

Address

Country

Street

City

Region

Postal Code

Pastor 1
Title

Pastor 1
First Name

Pastor 1
Middle Initial

Pastor 1
Last Name

Pastor 1
Suffix

Pastor 2 Name

Youth / CE

Nominator Information

Title

First Name

Middle Initial

Last Name

Suffix:

Denomination (select one)

Please Select:

Pastor

Youth/CE

Church Member

Certified Lay Pastor (CLP)

Email

Phone

Home Address:

Country

Street

City

Region

Postal Code

Westminster College Alumni?

Yes

Class year

NOMINATION

Please tell us more about how the student you are nominating has been involved in your congregation, community and school.

(The nomination box below is not limited. It will expand to fit the text entered.)

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