Church Matching Grant

Student Name

First Name

Last Name

Social Security/ Social Insurance Number

Anticipated Credit Hours – Fall:

Anticipated Credit Hours – Winter:

From Canada? Have you completed Kuyper’s Canadian Financial Aid Application?

Yes No

Have you completed your Free Application for Federal Student Aid (FAFSA)?

Yes No

International? Have you completed Kuyper’s International Student Statement of Finances form?

Yes No

Church Name:

Church Phone Number

Church Address

Address Line 1

Address Line 2

City

State

ZIP Code

Church Official's Name

First Name

Last Name

Church Official's Title

Church Commitment $

Check Number

If you are including funds with this application, please remember:

Incomplete and/or unsigned forms cannot be accepted or processed and will be returned.

Student Signature

Use your mouse or finger to draw your signature above

Date

Church Official's Signature

Use your mouse or finger to draw your signature above

Date

Please Note Important Deadlines:

Fall Only and Full Year application deadline is August 1, 2021, and the church check must be received by October 1, 2021.

Winter Only application deadline is December 1, 2021, and the church check must be received by February 1, 2022.

These deadlines are non-negotiable and applications and/or church funds received after these dates cannot be matched.