National Junior High Conference 2023 Scholarship Request form

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This scholarship is for youth and advisors who live west of the Mississippi River.

Email *

Scholarship recipient first name: *

Scholarship recipient last name: *

Scholarship recipient's advisor:

What is your church code? (Don't know it?) *

Please make the reimbursement check payable to: *

The check will be sent to the church unless another address is provided below.

I understand that AFTER I have registered and paid my registration fee, the Youth/Young Adult Ministry Office will send me a reimbursement check in the amount of $250.
*

Yes

I agree that I will return the travel scholarship if I do not attend National Junior High Conference.
*

Yes

As a way of expressing my thanks to the Church of the Brethren for this travel scholarship, I agree to help with worship (read scripture, participate in a drama, etc.) at National Junior High Conference or express my thanks another way (write a story about my experience, create a piece of artwork, share my photos, etc.).

Yes

Youth: By typing my name below, I am signing this form. *

Parent/guardian/advisor: By typing my name below, I am signing this form. *

A copy of your responses will be emailed to the address you provided.

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