CCWC 2020

Please note: A Vickie Baker and partial scholarship cannot be combined, but you are welcome to apply for both.
Three $100 scholarships will be awarded on a first come basis so the sooner you apply, the better opportunity you will have to be chosen.

Date:	mm/dd/yyyy format
Title:
First Name:
Mid Init:
Last Name:
Address:
City:
State:	Select ** -- **Blank** AK -- Alaska AL -- Alabama AR -- Arkansas AZ -- Arizona CA -- California CO -- Colorado CT -- Connecticut DC -- District of Columbia DE -- Delaware FL -- Florida GA -- Georgia GU -- Guam HI -- Hawaii IA -- Iowa ID -- Idaho IL -- Illinois IN -- Indiana KS -- Kansas KY -- Kentucky LA -- Louisiana MA -- Massachusetts MD -- Maryland ME -- Maine MI -- Michigan MN -- Minnesota MO -- Missouri MS -- Mississippi MT -- Montana NC -- North Carolina ND -- North Dakota NE -- Nebraska NH -- New Hampshire NJ -- New Jersey NM -- New Mexico NV -- Nevada NY -- New York OH -- Ohio OK -- Oklahoma OR -- Oregon PA -- Pennsylvania PR -- Puerto Rico RI -- Rhode Island SC -- South Carolina SD -- South Dakota TN -- Tennessee TX -- Texas UT -- Utah VA -- Virginia VI -- Virgin Islands VT -- Vermont WA -- Washington WI -- Wisconsin WV -- West Virginia WY -- Wyoming
Zip:
Day Phone:
Night Phone:
Cell Phone:
Email:
Website:
Blog:

Please answer the following questions.

Briefly share your testimony:

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Why do you believe God is calling you to write your story in book form?

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What format have you chosen to share your story (memoir, personal experience story, fiction based on life experience, devotional/inspirational, self-help) and how much is completed?

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What do you hope to gain from the conference?

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Why do you need scholarship help?

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