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California Peace Officers' Memorial Foundation

Honoring Our Fallen Heroes

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Online Scholarship/Grant Application

California Peace Officers’ Memorial Foundation
2018/2019 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.

Name*
First Last
Birth Date
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Email
Peace Officer Information
Name of peace officer killed in the line-of-duty:*
First Last
Officer's employing agency:*
Officer's End of Watch date:*
Your relationship to peace officer:*
College or Business/Trade School Information
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 please state 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
OPTIONAL: Upon receipt of CPOMF Scholarship Program funds, I give permission for CPOMF to use my photo in print material and on the CPOMF website relating to their Scholarship Program.
- Yes
- No
Upload Photo
Comments
This field is for validation purposes and should be left unchanged.

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