Golden's Bridge Fire Department Scholarship Application Form

PAUL R. DAUR CONTINUED EDUCATION GRANT and HENRY T. MARTIN MEMORIAL SCHOLARSHIP

The information provided on this form will be used by the Goldens Bridge Fire Department Scholarship Committee to select recipients for scholarships. It is important that you give complete details concerning your college/career plans, activities and financial information (if applicable).
BASIC INFORMATION

Application must be filed no later than March 15, 2021
Student's Full / Legal Name *

First Name Last Name
Student Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Student Phone Number *

Area Code Phone Number
Student E-mail *
Student Birth Date

Month Day Year
Gender

Academics
Academic GPA *
Schools to which you are applying
School 1
School 2
School 3
School 4
School 5
School 6
Will Live
Major(s) You Are Considering

In order of preference, list the major(s) you are considering.
Major 1
Major 2
Major 3

REFERENCES:

Please list one educator and at least one community person who would recommend you for a scholarship. Please do not list the person who completes a scholarship recommendation for you.
Reference 1 Name (Position,Phone Number)
Reference 2 Name (Position,Phone Number)

SCHOOL / COMMUNITY ACTIVITIES / WORK / EXPERIENCE/SPORTS/AWARDS/ETC:

List name of club, etc. and years of participation. If you volunteered, list the name of organization and the number of hours, weeks and years that you volunteered. If you worked, list the company, hours per week and length of time. Attach an additional sheet or resume if necessary.
School Activities / Offices Held 1: (not sports)
School Activities / Offices Held 2: (not sports)
School Activities / Offices Held 3: (not sports)
School Activities / Offices Held 3: (not sports)
Community Service / Volunteer Activities 1 (outside of school)
Community Service / Volunteer Activities 2 (outside of school)
Community Service / Volunteer Activities 3 (outside of school)
Sports Participation 1
Sports Participation 2
Sports Participation 3
Will you be participating in a sport(s) this year?

Yes No
What Sport?
Travel Experience or Unusual Experiences (study abroad, etc.)
School / Community Awards and Honors 1 (no matter how small) CSF, GSE, National Honor Society, Girl/Boy Scouts, 4-H, Governor’s Scholar, etc.
School / Community Awards and Honors 2
School / Community Awards and Honors 3
EMPLOYMENT 1: List past and present work and length of time employed.
EMPLOYMENT 2: List past and present work and length of time employed.
EMPLOYMENT 3: List past and present work and length of time employed.

First generation to attend college?

Yes No
(This section is optional) Please explain any unusual circumstances such as, child-support ending, emergency expenses, medical bills, seasonal work, unemployment, etc. that will impact your ability to fund your college education.

SCHOLARSHIP RECEIVED TO DATE 1
AMOUNT 1
SCHOLARSHIP RECEIVED TO DATE 2
AMOUNT 2
STUDENT STATEMENT(Use this section to fill in any blanks our application may have missed, or just tell us a great story!): *
Submission Time

Month Day Year Hour Minutes AM/PM Option
Should be Empty:

PAUL R. DAUR CONTINUED EDUCATION GRANT and HENRY T. MARTIN MEMORIAL SCHOLARSHIP