Poland Presbyterian Church
Session & Deacons
Facility Use Policy
Media & Resources
Presbyterian Church USA
Capital Campaign Brochure
Sunday School Registration
2017 Pledge Card
Home Phone Number
Cell Phone Number
Name of High School(s)
In the box below please explain all your church activities and service from 5th grade to now. Include the grades/years of your service as well as the approximate hours spent each week/year. Examples include acolyte, usher, mission trips, youth deacon, VBS volunteer, Strawberry Festival workers, etc.
Comments: Please explain how any or all of the above listed experiences contributed to you as a person and/or as a Christian.(For Scholarship Committee use only: Score: 0-40pts. Score_____)
Date ACT Taken:
ACT English Score:
ACT Reading Score:
ACT Science Score:
ACT Combined English/Writing Score
Date SATI/SAT Taken:
SATI/SAT Verbal/Critical Reading Score:
SATI/SAT Math Score:
SATI/SAT Writing Score:
Any other tests required for post- secondary education. Date Taken:
Grade Point Average:
9th Gr. Courses Taken ( i.e. Honors, AP, Etc.)
10th Gr. Courses taken ( i.e. Honors, AP, Etc.)
11th Gr. Courses taken ( i.e. Honors, AP, Etc.)
12th Gr. Courses taken ( i.e. Honors, AP, Etc.)
9th Gr. GPA
10th Gr. GPA
11th Gr. GPA
12th Gr. GPA
Comments: Please explain how any or all of the above listed classes/ teachers contributed to you as a student. Please use this space to list any honors or awards received. If you are not attending a college or university, please explain. (For Scholarship Committee use only: Score: 0-20_____score)
In the area below please tell us about your school, community and extracurricular activities. Include any honors classes, clubs, sports, groups and hobbies. Please include the number of years/grades (9th-12th gr.) for each as well as the amount of time spent per week/year for each.
Comments: Please feel free to explain how any or all of the above listed activities contributed to you as a person.(For Scholarship use only: Score 0-10pts. Score_____)
Name of College you plan to attend:
Financial Aid for which you applied:
Financial Aid which you will receive:
Scholarship(s) for which you applied:
Scholarship(s) which you received:
Net annual education costs:
Do you have any other members of your household attending college/university at this time?
If "Yes", please explain below their relationship to you, the institution attending, degree and expectant date of completion. Include information on ALL household members currently attending a college/university at this time:
Please explain your need: (For Scholarship use only: Score 0-5pts. Score ____)
In the box below please write an essay (250-500 words) on one of the following subjects:
1) Evaluate a significant experience, achievement, risk you have taken, or ethical dilemma you have faced and its impact on you.
2) Discuss some issue of personal, local, national, or international concern and its importance to you.
3) Indicate a person who has a significant influence on you, and describe that influence.
4) Describe a character in fiction, a historical figure, or a creative work (as in art, music, science, etc.) that has had an influence on you, and explain that influence.
5) A range of academic interests, personal perspectives, and life experiences adds much to the educational mix. Given your personal background, describe an experience that illustrates what you would bring to the diversity in a college community, or an encounter that demonstrated the importance of diversity to you.
6) Topic of your choice.
These topics were created by the
2006 The Common Application, Inc
. and used in
The Common Application for Undergraduate College Admission.
Please write a 250-500 word essay on one of the above six subjects: (For Scholarship Committee use only: Score 0-25pts. Score_____)
denotes required fields. If application will not submit please check that all required fields have been completed.
2 Poland Manor • Poland, Ohio 44514 • 330-757-1547