2013 Summer Theological Academy Application

Fields marked with an asterisk ( * ) are required.

First Name *
Middle Name
Last Name *
Street Address *
City *
State

Zip *

Home Phone *
E-mail Address *
Gender *

Date of Birth *

’12-’13 School Year Grade Level *

What part(s) of the word do you trace your predominant ethnic heritage? (Check one or more)







Other (please specify)
Name(s) of parent(s) or legal guardian(s) *

Congregation

Congregation Name
Congregation Address
City
State

Zip

Church Phone #
Denomination
Synod (if ELCA)
Personal Hobbies, Special Interests, Activities, Organizations?
I certify that all of the information in this application is correct to the best of my knowledge. I acknowledge that for my application to be complete and considered I must submit 4 completed essay questions, 2 recommendations, and my academic transcript (information on all of these pieces will be available after submitting this form) I understand that I must successfully complete my current year of high school and plan to enter the next class year in the fall of 2013. If I am accepted as a TEY scholar and choose to attend, I agree to participate for the full duration of the Academy and to live by the covenant and community expectations of the Academy.

(Please press only once)