Postmark DEADLINE: May 20, 2019

BEFORE completing this form,

Please see PUMBC Youth Scholarship Program document for guidelines and requirements

Hand Delivered Applications Will NOT Be Accepted

Mail All Pages To: Progressive Union MB Church

Attn: Mary Jones Moore/PUMBC Scholarship Committee

1919 Brandon Town Road
Huntsville, AL 35816
Instructions for completion of application:
1. All blanks must be completed. If information is not-applicable, please write N/A in the blank.
2. Application must be signed and dated.
3. Information must be complete, accurate, and TYPED. Handwritten applications will not be
considered.

Are You an American Citizen:
YesNo

Home Address: Street | City,State | Zip

In what church, extracurricular and community activities have you been especially involved?