Nomination Form for Martin Luther Scholar Award

Student Information

First Name

Last Name

Country

Street

City

Region

Postal Code

Phone #

Personal Email

School

School GPA

School Grad Year

Church Name

Church Affiliation

Church Address

Country

Street

City

Region

Postal Code

What affiliation are you a part of

Nomination Information

Title

First Name

Last Name

Phone #

Email

Wittenberg University Alumni/Alumnae

Yes

No

Alumni Class Year

Is your address different from the church?

Yes

No

Street

City

State

Zip Code

Please attach a recommendation letter about the student you are nominating for the Martin Luther Scholar Award