Memorial Presbyterian Church - NY - Scholastic Achievement

Graduate & Scholastic Achievement Recognition Form

Student's First Name

Student's Last Name

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Phone Number

Email

Degree Earned

Graduating from (Name of School)

Date of graduation

Parent/Legal Guardian's First Name

Parent/Legal Guardian's Last Name

The church office must receive Recognition Forms
with a photo of the graduate by Friday, June 19, 2026.

*Please note: Only complete applications will be processed

*Graduates will be recognized at a celebration in July of 2026.