CALIFORNIA PEACE OFFICERS' MEMORIAL FOUNDATION
2012 SCHOLARSHIP/GRANT APPLICATION


Dependents of California peace officers who have died in the line of duty are eligible to receive annual scholarships from the California Peace Officers’ Memorial Foundation.

 

Please fill out the form below:

Name

Birth Date

Street Address

City     State    Zip

Phone number

Email address

Name of peace officer killed in the line-of-duty:


Officer's employing agency:



Officer's End of Watch date:



Your relationship to peace officer:



College or Business/Trade School of choice:


(Proof of Enrollment must be Faxed to 916-944-2171 for application to be considered)

Intended Major:



Intended Career:



G.P.A. at last school attended:

Have you previously applied for and/or received a scholarship from the California Peace Officers Memorial Foundation? If yes, please list dates and provide most recent transcripts:



In the space below, write a statement indicating why you feel you are deserving of a financial award.
This section must be completed.



All of the information provided in this application is true to the best of my knowledge and I have read and understand the award requirements: Yes No