FDNY 2016 Hispanic Society Scholarship Application
City _____________________ State ______ Zip Code ____________
Birth date __________ Telephone ______________________
Name of parent _______________________ Telephone: _____________
Date of appointment: _________ SS# (last 4)________ Tax# __________
Unit assigned: _______________ Rank: ___________________
Current status of applicant: High school _____ College _____ Other ____
Number of brothers and sisters and their ages: ___________________________________________________________
Number of dependent brothers or sisters attending college: ____________
(If living at home)
Have you received any other scholarships: Yes ( ) No ( )
If so, specific: _______________________________________________
List activities in which you have participated: ___________________________________________________________
(Such as school/church/community, etc.)
List offices to which you have been elected: ___________________________________________________________
(In any organization)
List of honors which you have been awarded: ___________________________________________________________
List names and addresses of universities or colleges you plan to attend or are presently attending: _____________________________________________
Signature of applicant: _______________________ Date: _________
Signature of parents: _________________________ Date: _________
If granted a scholarship and I fail to complete the school term for reasons other than sickness of physical injury, I agree to return any scholarship money received by me to the Hispanic Society Fire Department of New York within (60) days from date my enrollment has terminated.
I further state that I consent to providing the information requested in the application. I have provided this information freely and voluntarily and hereby waive any objections to providing this information which might be made pursuant to the Privacy Act, 5 U.S.C. Section 552a. The Hispanic Society Fire Department City of New York has my permission to use the information given in considering and processing my application.
(Signature of applicant) (Date)
All applications must be accompanied by and the Deadline is 9/30/2016
1. A copy of the applicant’s school transcript.
2. A letter from the applicant with specific facts as to the desire to continue his or her education and why financial assistance is required.
3. Two letters of recommendation verifying this application, and giving general personal traits, (must be form minister, community leader, elected official, etc.)
4. Letter of academic reference from principal, counselor, dean or professor.
5. Short essay on “Changing the world as I see it today”
Mail to: FDNY Hispanic Society
Woodside, NY 11377
Or email application to: email@example.com
(Attach separate sheet of paper as needed)