Discovery! Scholarship Follow Up Form

Scholarship Follow Up Form

Please complete the following form.

*All Fields Required

Date:

Class # :

First Name:

Last Name:

Address:

City:

State:

Zip:

Home Phone:

Work Phone:

Cell Phone:

Email:

Referred By:

Please list the month & year you attended the following:

Refocus:

Spiritual:

Have you referred anyone for D1?

If so, who?

Have you served on a TA team?

Have you watched the movie, Pay It Forward?

Have you made a tax-deductible donation to pay back all or part of your scholarship?

If not, are you able to make a contribution at this time to "pay it forward"?

Any amount ($10, $20, $50, $100) will help bless the lives of others.

What did Discovery! do for you? Share with us how your life has changed since attending Discovery!.The power of your personal testimony has the ability to save lives. People wanting to know what HOPE means will see it in your words. Please be specific and give detailed answers.

Spiritual:

Personal:

Relationships:

Career:

May we use your testimony on our website or brochure?

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