Lutheran School of Theology at Chicago TEEM Certificate Financial Assistance Application

First Name

Last Name

City

State

Zip

Phone Number

Email

Congregation Address

Financial Assistance Request Amount Amount of financial assistance you are requesting.

Personal Contribution Amount Amount you are able to contribute toward tuition.

Synod Support Yes No Will your synod provide financial support?

Congregational Support Yes No Will your congregation provide financial support?

Other Sources of Financial Support Are there other sources providing financial assistance (e.g., grants, scholarships, other organizations)?

Statement of Financial Need Please briefly describe your financial need and any special circumstances that should be considered when reviewing your application.

* By submitting this form, I certify that the information provided in this application is accurate to the best of my knowledge. I understand that financial assistance is limited and based on availability.

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