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Global Mission
International Leadership Development Program
INTERNATIONAL SCHOLARSHIP APPLICATION FORM CHECKLIST
The Evangelical Lutheran Church in America (ELCA), through its Global Mission unit (GM), offers a limited number of scholarships to
companion churches and institutions. The goal is to accompany these churches and institutions in their various leadership development
needs. The scholarship is intended for the church or institution and not as a personal scholarship.
Please respond to all questions, even if the answer is “none” or “not applicable.” If possible, please complete online and submit electronically;
otherwise print legibly. The application is to be completed in English (preferable), French or Spanish.
A complete scholarship application will include the following:
□□
The core application form (International Scholarship Application Form) — to be completed by the applicant.
□□
Teacher Form (Confidential Letter of Recommendation) — to be completed by two different present or former teachers.
□□
Personal Form (Confidential Letter of Recommendation) — to be completed by two different individuals (not relatives) who have
known the applicant for at least three years.
□ Institutional Endorsement Form — to be completed if the applicant is being endorsed by a source other than, or in addition to, a
companion church. This form is to be completed by the authorized official of the institution or agency.
□ Church Endorsement Form — to be completed by an authorized official of the ELCA companion church.
□ Certificate of Health Form — to be completed by a medical doctor in conjunction with a physical examination.
□ Narrative of Self, Faith Statement and Goals.
□ Estimated Budget Worksheet or copy of official school budget — school fees and living expenses if applicable (If not attending
an ELCA institution.)
□ Acceptance Letter from educational institution you plan to attend (If not attending an ELCA institution.)
□ The Description of Proposed Study Program, Aims and Goals (page 9) is to be completed in detail.
Please include physical copies of:
□□
If academic study is intended in an English-medium setting, the Test of English as a Foreign Language (TOEFL) is required. Educational
institutions in the United States of America will not consider an application from a potential international candidate
without a current TOEFL score. If you do not take the TOEFL, you must take the Graduate Record Examination (GRE – graduate
studies) or the Scholastic Aptitude Test (SAT – for undergraduate studies). If you have taken the TOEFL test within the last two
years, you must include a copy of your TOEFL score with your scholarship application. If you have not already taken the TOEFL
test, do so immediately and have the results sent to the ELCA/GM office. Please use the TOEFL institutional code 9295. The
International English Language Testing System (IELTS) is an appropriate alternative.
□□
Please have Official Academic Transcripts from educational institutions where you have studied forwarded to the Director for
International Leadership Development at the address listed below.
applicant information: please fill out via pdf or print legibly
Name
last name (as appears on passport/birth certificate/etc.)
first name/given name (as appears on passport/birth certificate/etc.)
other name(s)
title (rev/dr/ mr/mrs/ms/other - please specify)
National Church Membership
8765 West Higgins Road ● Chicago, Illinois 60631-4101 ● Phone 773-380-2700 Fax 773-380-2410 ● www.elca.org
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INTERNATIONAL SCHOLARSHIP APPLICATION FORM
Global Mission
International Leadership Development Program
NOTE: Application deadline is October 15 of each year for programs that begin after February 1 the following year.
1 personal information
Name
last name (as appears on passport/birth certificate/etc.)
first name/given name (as appears on passport/birth certificate/etc.)
other name(s)
title (rev/dr/mr/mrs/ms/other - please specify)
Birth Date Country of Citizenship Country of Residence
mm/dd/yyyy
Mailing Address
Permanent Address (If different from mailing address)
street address (apartment residents - include unit number here as well)
street address (apartment residents - include unit number here as well)
city/town state/province postal code
city/town state/province postal code
Email
country
country
Cellphone (Mobile)
Passport Number
Issued By
country
Dates of Validity
mm/dd/yyyy - mm/dd/yyyy
2 emergency contact information
Name
Address
street address city/town state/province postal code country
Relationship
Phone
Email
3 standardized test information
Check one:
□□
TOEFL
□□
GRE
□□
SAT
□□
IELTS
Score
or Scheduled Test Date
mm/dd/yyyy
For study in English language settings, please provide a copy of the results.
8765 West Higgins Road ● Chicago, Illinois 60631-4101 ● Phone 773-380-2700 Fax 773-380-2410 ● www.elca.org
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4 church affiliation information
National Church Membership
Congregational/Parish Membership
Date of Baptism
mm/dd/yyyy
If clergy, date of ordination
mm/dd/yyyy
5 family information
Marital Status (Please check one)
Full Name of Spouse
□□
Married
□□
Single
last name (as appears on passport/birth certificate/etc.)
first name/given name (as appears on passport/birth certificate/etc.)
other name(s)
title (rev/dr/mr/mrs/ms/other - please specify)
Birth Date
Birth Place
mm/dd/yyyy
town/province/ district/ country
Country of Citizenship
Country of Residence
Can your spouse read or speak English?
Read (check one):
□□
Yes
□□
No
Speak (check one):
□□
Yes
□□
No
Children
1. Name
Gender:
□□
Male
□□
Female
Birth Date
mm/dd/yyyy
Citizenship
country
2. Name
Gender:
□□
Male
□□
Female
Birth Date
mm/dd/yyyy
Citizenship
country
3. Name
Gender:
□□
Male
□□
Female
Birth Date
mm/dd/yyyy
Citizenship
country
4. Name
Gender:
□□
Male
□□
Female
Birth Date
mm/dd/yyyy
Citizenship
country
FOR THOSE SEEKING STUDY IN THE UNITED STATES
Do you have any family members presently living in the United States of America? (check one)
(family members: spouse/children/parents/brothers/sisters/grandparents/aunts/uncles/cousins)
□□
Yes
□□
No
Please list all relatives living in the United States of America:
1. Name
Phone Number
Address
Relationship
street address city/town state/province postal code
Number of years in the U.S.A.
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5 family information (continued)
2. Name
Phone Number
Address
Relationship
street address city/town state/province postal code
Number of years in the U.S.A.
3. Name
Phone Number
Address
Relationship
street address city/town state/province postal code
Number of years in the U.S.A.
6 academic information
(including past and present)
Secondary/High School
Name
Address
street address city/town state/province postal code country
Entrance Date
mm/yyyy
Graduation/Departure Date
mm/yyyy
Degrees Received or Credits Earned
Field of Specialization (if any)
College/University/Seminary
Name
Address
street address city/town state/province postal code country
Entrance Date
mm/yyyy
Graduation/Departure Date
mm/yyyy
Degrees Received or Credits Earned
Field of Specialization (if any)
College/University/ Seminary
Name
Address
street address city/town state/province postal code country
Entrance Date
mm/yyyy
Graduation/Departure Date
mm/yyyy
Degrees Received or Credits Earned
Field of Specialization (if any)
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6 academic information (continued)
Post Graduate/Other/Special
Name
Address
street address city/town state/province postal code country
Entrance Date
mm/yyyy
Graduation/Departure Date
mm/yyyy
Degrees Received or Credits Earned
Field of Specialization (if any)
Other Experience or Training
International Travel or Study Experience (please explain)
7 language proficiency - ancient or modern
Languages
Speak:
Speak:
Speak:
Speak:
□□Fluent
□□Fluent
□□Fluent
□□Fluent
□□Conversational
□□Conversational
□□Conversational
□□Conversational
Read:
Read:
Read:
Read:
□□Yes
□□Yes
□□Yes
□□Yes
□□No
□□No
□□No
□□No
Write:
Write:
Write:
Write:
□□Yes
□□Yes
□□Yes
□□Yes
□□No
□□No
□□No
□□No
For those seeking study in English-medium countries, have you taken any courses or participated in any activities where
English was the primary language? (If yes, when and where?) □□Yes
□□No
8 work history
(begin with current or most recent position)
1. Dates of Employment
Organization/Employer
mm/yyyy -mm/yyyy
Title/Position
Type of Work
2. Dates of Employment
Organization/Employer
mm/yyyy -mm/yyyy
Title/Position
Type of Work
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8 work history (continued)
3. Dates of Employment
Organization/Employer
mm/yyyy -mm/yyyy
Title/Position
Type of Work
4. Dates of Employment
Organization/Employer
mm/yyyy -mm/yyyy
Title/Position
Type of Work
9 financial information
How much money can you contribute to the cost of your education?
If you have a family, what provisions will be made for the support of your spouse and children during your absence?
10 medical information
Are you or any member of your family under treatment or observation for any illness or injury?
□□
Yes
□□
No
If yes, please give details:
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CONFIDENTIALITY AGREEMENT
Global Mission
International Leadership Development Program
Please initial appropriate option below. We recommend that you initial option one. Doing so enables us to carry out our
selection process more effectively.
Option One
I waive all rights to read any letters of reference (two Teacher
Confidential Letters of Recommendation and two Personal
Confidential Letters of Recommendation) submitted with this
application, as provided for in the United States of America
Family Educational Rights and Privacy Act of 1974.
Option Two
I do NOT waive rights of access.
Applicant’s Signature
Date
mm/dd/yyyy
PLEASE UPLOAD A PHOTOGRAPH VIA EMAIL
appendices
DESCRIPTION OF PROGRAM (pages 9-10 )
PERSONAL NARRATIVE, FAITH STATEMENT AND GOALS (page 11)
PERSONAL COMMITMENT AGREEMENT (page 13)
TEACHER RECOMMENDATION FORMS (pages 15-18 - two copies)
PERSONAL RECOMMENDATION FORMS (pages 19 - 22 - two copies)
INSTITUTIONAL ENDORSEMENT FORM (page 23)
and/or CHURCH ENDORSEMENT FORM (page 25)
CERTIFICATE OF HEALTH FORM (page 27)
ESTIMATED BUDGET WORKSHEET (page 29)
8765 West Higgins Road ● Chicago, Illinois 60631-4101 ● Phone 773-380-2700 Fax 773-380-2410 ● www.elca.org
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International Leadership Development Program
DESCRIPTION OF STUDY PROGRAM, AIMS AND GOALS FOR THE FUTURE
(To be completed by applicant)
Name of Applicant
1. Description of the study or training program for which you are requesting scholarship support.
2. What area of study or research do you intend to pursue? Please check one in the degree/program box and one area of
concentration.
degree/program
□ □
□ □
□ □
□ □
□ □
□ □
□ □
□
□ □
□ □
□ □
□ □
□ □
Certificate/Diploma
Undergraduate Degree
Honours
Licenciatura
MA — Master of Arts
MDIV — Master of Divinity
MTh — Master of Theology
□ Graduate Certificate
DMin — Doctor of Ministry
PhD — Doctor of Philosophy
ThD — Doctor of Theology
Research Scholar
Other (Please describe):
area of concentration
□ □
□ □
□ □
□ □
□ □
Biblical Studies: Old Testament/ New Testament/
Scriptural Theology
Church History/ Historical Studies
Ethics/Church and Society
Systematics/Constructive Theology
Practical Theology (check one):
□ □ Conflict Resolution □ □ Mission/Interfaith
Relations
□ □ Congregational &
Community Care □ □ Pastoral Care &
Counseling
□ □ Congregational
Ministries & Leadership □ □ Religion & Science
□ □ Cross-cultural □ □ Social Work
□ □ Education □ □ World Christianity
□ □ Evangelism □ □ Worship
□ □ Homiletics (preaching) □ □ Youth & Family
□ □ Other (specify):
3. Is this study program available in your home country or nearby country? If yes please explain below: □□
Yes
□□
No
4. Proposed place of study or training (Please list no more than three): 1)
2) 3)
5. Duration of proposed study or training:
start date mm/yyyy
end date mm/yyyy
6. What date do you hope to begin your studies?
8765 West Higgins Road ● Chicago, Illinois 60631-4101 ● Phone 773-380-2700 Fax 773-380-2410 ● www.elca.org
GM_ISA_04162013_v001 9
mm/yyyy

7. Have you been accepted?
□□
Yes
□□
No
8. Please describe your future assignment in your church.
(Include letter of acceptance and expected start date)
mm/yyyy
9. How will your study program assist you in your future service to your church? How will this benefit your church?
10. How would this program assist your growth as a person?
11. Other comments that will assist us in understanding your goals and aims for the future.
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Global Mission
International Leadership Development Program
PERSONAL NARRATIVE, FAITH STATEMENT AND GOALS
Please write a narrative description of yourself (500-750 words). Provide information about significant events of your life and a brief
statement of your Christian faith. Also, include your academic and vocational goals and how the proposed program will affect your
church's future.
8765 West Higgins Road ● Chicago, Illinois 60631-4101 ● Phone 773-380-2700 Fax 773-380-2410 ● www.elca.org
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PERSONAL COMMITMENT AGREEMENT
(To be signed by applicant and returned with application)
Global Mission
International Leadership Development Program
1. I promise to return to my home country as soon as my studies or other approved activities under the sponsorship of the
Evangelical Lutheran Church in America (ELCA) have officially been terminated.
2. I promise not to solicit any funds or privileges for personal/family use or for any home church personnel/projects during
the period of my scholarship.
3. I promise to notify the ELCA of any health changes that may occur after the issuance of the “Certificate of Health”
submitted with this application.
4. I promise that my dependents, if any, will be adequately cared for during my absence. I promise I will not solicit funds
on their behalf.
5. I promise not to make any changes in my approved study program without the prior approval of the ELCA/Global
Mission Director for International Leadership Development. I will not seek additional studies beyond that for which this
scholarship is approved.
6. I promise to repay the full amount of the scholarship grant if, A) I do not fulfill all agreements made with my church or
institution in regard to service after the completion of my study program or B) I do not fulfill all agreements made with
the Evangelical Lutheran Church in America.
7. I certify that the information in this application and appendices is true and complete to the best of my knowledge and
ability.
Signature
Name (Please print)
Date
mm/dd/yyyy
for gm use
Director for Leadership Development
Date
mm/dd/yyyy
mailing information
Please save document before submitting or mail completed application to:
Director for International Leadership Development
Evangelical Lutheran Church in America - Global Mission
8765 West Higgins Road
Chicago, IL 60631 USA
Phone: 1-773-380-2650 Fax: 1-773-380-2410 www.ELCA.org Email: Globalscholars@elca.org
note: Application deadline is October 15 of each year for programs that begin after February 1 the following year.
8765 West Higgins Road ● Chicago, Illinois 60631-4101 ● Phone 773-380-2700 Fax 773-380-2410 ● www.elca.org
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