Student Essay Application Form

* Required Information

Student Name *

Age *

Parent or Legal Guardian *

Address *

City *

State *

Zip *

Email Address *

Phone *

Student Chosen Career

Reason for Choosing this Career

What step has student taken to pursue chosen career?

How will students career choice positively impact the community?

Please sign the form below indicating your permission / request for your child to participate in the Hopes and Dreams Program. Return to Community Outreach Word of Deliverance Ministries at 650 27th St. E. Bradenton, FL 34208.

Student Name *

Parent / Guardian Signature *

Clear if the signature is not legible

Date *

Attached Digital Copy of Your Essay Here

Choose a file