THE ANNIE L. NIXON MEMORIAL SCHOLARSHIP FUND OF THE MACEDONIA BAPTIST CHURCH 141 SOUTH NINTH AVENUE MOUNT VERNON, NEW YORK 10550 Senior Pastor: Rev. Dr. Darren M. Morton Assistant Pastor: Rev. Joyce W. Somerville Application Form CHECK ONLY ONE BOX BELOW: □ Applying for an academic scholarship based upon the highest average. □ Applying for undergraduate financial assistance. □ Applying for graduate financial assistance based upon demonstrated financial need and academic achievement. Name: Address: Apt #: City: State: ZIP Code: Date of Birth: Tel No.: Previous address: City: ZIP Code: Occupation: (if student, please indicate student) Marital Status: Check One Box Below □ Never Married □ Married □ Widowed □ Separated or Divorced CHURCH MEMBERSHIP: A. All applicants are required to be a member of the Macedonia Baptist Church. B. Please give approximate date of membership: ________ ____ ____ Month Day Year EMPLOYMENT: Employer: Employer address: How long: ___________ Phone: City: State: Zip Code: FAMILY INFORMATION: Mother’s Name: Address:
THE ANNIE L. NIXON MEMORIAL SCHOLARSHIP FUND OF THE MACEDONIA BAPTIST CHURCH 141 SOUTH NINTH AVENUE MOUNT VERNON, NEW YORK 10550 Senior Pastor: Rev. Dr. Darren M. Morton Assistant Pastor: Rev. Joyce W. Somerville Application Form CHECK ONLY ONE BOX BELOW: □ Applying for an academic scholarship based upon the highest average. □ Applying for undergraduate financial assistance. □ Applying for graduate financial assistance based upon demonstrated financial need and academic achievement. Name: Address: Apt #: City: State: ZIP Code: Date of Birth: Tel No.: Previous address: City: ZIP Code: Occupation: (if student, please indicate student) Marital Status: Check One Box Below □ Never Married □ Married □ Widowed □ Separated or Divorced CHURCH MEMBERSHIP: A. All applicants are required to be a member of the Macedonia Baptist Church. B. Please give approximate date of membership: ________ ____ ____ Month Day Year EMPLOYMENT: Employer: Employer address: How long: ___________ Phone: City: State: Zip Code: FAMILY INFORMATION: Mother’s Name: Address: