THE MONTGOMERY COUNTY, OHIO LAW

ENFORCEMENT OFFICERS MEMORIAL

FOUNDATION SCHOLARSHIP

Official

Application Form

2013

The Montgomery County, Ohio Law Enforcement Officers Memorial Foundation’sScholarship has been established to foster the memory and to memorialize those law enforcement personnel who have given their lives in order to protect and to serve our various communities. To that end, three$1,000.00 scholarships may be awarded to successful applicants who are currently graduating high school seniors, or returning college studentswho are previous recipients. It is important to note that consideration will be given, in the following order, to applicants who are 1: the child of a fallen law enforcement officer from Montgomery County, Ohio, (regardless of major) 2: a family member of a fallen law enforcement officer from Montgomery County, Ohio, (regardless of major) 3: a police officer’s family member, 4: a Montgomery County resident intending upon pursuing a law enforcement career, and 5: a Montgomery County,Ohio high school studentor reapplying recipient, pursuing a degree in Criminal Justice, Criminology, Forensics, Education, or Social Work.

In the event that additional space is necessary to completely answer a question, please attach an additional 8 and ½ by 11 sheet of paper with your name and your address in the upper right hand corner, rather than utilizing the back of this application. All information contained upon the application will be kept strictly confidential and will be viewed only by authorized representatives of The Montgomery County, Ohio Law Enforcement Officers Memorial Foundation’s Scholarship Committee. Incomplete forms will not be considered.

This application must be completed, signed and received by The Montgomery County, Ohio Law Enforcement Officers Memorial Foundationin a sealed envelope, with a postmark ofno later than March 15, 2013. Applications bearing postmarks after this date will not be considered.

All submitted scholarship applications will become the property of The Montgomery County, Ohio Law Enforcement Officers Memorial Foundationand will not be returned.

Please type or print, using black ink. Neatness, legibility and thoroughness in your responses may have an impact upon the decision of the selection committee. Should a question be encountered which is not applicable, please enter “not applicableor N/A” in the space provided.

THE MONTGOMERY COUNTY, OHIO LAW ENFORCEMENT OFFICERS MEMORIAL FOUNDATIONSCHOLARSHIP

GUIDELINES FOR SCHOLARSHIP APPLICATIONS

Scholarship funds are intended to be used by the recipient to assist with the cost of tuition, books, and other fees associated with obtaining a college degree.
Applicants are to use the official,“The Montgomery County, Ohio Law Enforcement Officers Memorial Foundation” scholarship application form when applying for consideration. Photocopies are acceptable. No other application form will be accepted.
Applicantsmust include a recent photograph with their application. Their name and address shall be placed upon the back of the photograph.
If sufficient acceptable applicants are available, three (3) scholarships may be awarded.
The total amount of each scholarship will be $1,000.00 and will be depositeddirectly to the school, prior to the first quarter or semester of the year in which the scholarship was awarded. The applicant must provide proof of enrollment at an accredited college or university.
Scholarships may be awarded to successful applicants who are currently graduating high school seniors, or returning college students who are previous recipients. It is important to note that consideration will be given, in the following order, to applicants who are 1: the child of a fallen law enforcement officer from Montgomery County, Ohio, (regardless of major) 2: a family member of a fallen law enforcement officer from Montgomery County, Ohio, (regardless of major) 3: a police officer’s family member, 4: a Montgomery County resident intending upon pursuing a law enforcement career, and 5: a Montgomery County, Ohio high school student or reapplying recipient, pursuing a degree in Criminal Justice, Criminology, Forensics, Education, or Social Work.
Applicants must submit transcripts of their high school grades for their entire sophomore year through the first semester of their senior year at the time of their application. Returning college students must submit their most recent college transcripts.
At least two letters of recommendation must be included with the application.
A selection team comprised of members of The Montgomery County, Ohio Law Enforcement Officers Memorial Foundation appointed by the chairman of the scholarship committee willreview all timely submitted applications and shall make the selection(s). Their decision(s) shall be final.
Scholarship recipient(s) must attend The Montgomery County, Ohio Law Enforcement Officers Memorial Foundation’sCeremony, at which time the award(s) will be presented. The recipient(s) should be prepared to speak during the ceremony.
The selection committee shall inform the recipient(s) of the date, the time and the location of the Memorial Ceremony and of the mandated dress code. In addition, the recipient(s) will also be informed of any other pertinent information as deemed necessary.
The Montgomery County, Ohio Law Enforcement Officers Memorial Foundation’sScholarship Committee will expect written correspondence, no later than the end of February describing how the scholarship has assisted and benefited you.
This scholarship is for a $1,000.00 one-time payment. However, previous recipients may reapply for future consideration by following the steps listed in the official Scholarship Application, available at any Montgomery County High School’s Guidance Office.
Do not submit pages 1 through 2 with your application submission.
THE MONTGOMERY COUNTY, OHIO LAW ENFORCEMENT OFFICERS MEMORIAL FOUNDATIONSCHOLARSHIP

Please type or print using black ink. Neatness, legibility and thoroughness in your responses may have an impact upon the decision of the selection committee. In the event that you encounter a question that does not apply, please write, “not applicableor N/A” in the space provided.

Should a response require additional space, please attach an additional 8 and ½ by 11 sheet of paper with your name and your address in the upper right hand corner.

PERSONAL INFORMATION
Name (Last, First, Middle)
Home Address / City, State, Zip Code
Home Phone Number / Cell Phone Number / Date of Birth
I am a: (circle or underline → ) / (1) Graduating High School Senior, or
SAT/ACT Score(s) / (2) Returning College Student
Current GPA:
Social Security Number / High School Name (now attending) / College Name (now attending)
High School G. P. A.
College G. P. A. / High School Address / College Address
Father’s Name (Last, First, Middle) / Deceased? / When?
Is (was) father a law enforcement officer? / Yes / No
If yes: / Agency Name / Agency Address
Mother’s Name (Last, First, Middle) / Deceased? / When?
Is (was) mother a law enforcement officer? / Yes / No
If yes: / Agency Name / Agency Address
If your parents were law enforcement officers, was either killed in the line of duty? / Yes / No
Please describe the details on a separate piece of paper
Do you have a law enforcement family member that was killed in the line of duty? / Yes / No
Name of Officer / Relationship / Date of Death
Name of Agency / Address
Please describe the details on a separate piece of paper
PERSONAL INFORMATION - CONTINUED
CurrentHigh School Students
College Preferences: (Name of the two or the four year college / university) / Date Applied / Date Accepted
Choice #1:
Choice #2:
College Major:
HIGH SCHOOL ACTIVITIES
List all high school activities in which you have been an active participant, such as student government, honor society, clubs, sports and any special projects.
COMMUNITY ACTIVITIES WHILE IN HIGH SCHOOL
List all community activities in which you have been an active participant while in high school, whether paid or not, such as youth groups, church work, etc.
SPECIAL RECOGNITION - AWARDS AND HONORS
List all awards and special recognition that you have received while attending high school.
WORK EXPERIENCE
List all jobs that you have held while reaching your senior year of high school.
Employer / Nature of work / Employment dates / Number of hours worked
PERSONAL INFORMATION - CONTINUED
CurrentCollege Students
College Major:
COLLEGE ACTIVITIES
List all college activities in which you have been an active participant, such as student government, honor society, clubs, sports and any special projects.
COMMUNITY ACTIVITIES WHILE IN COLLEGE
List all community activities in which you have been an active participant while attending college, whether paid or not, such as youth groups, church work, etc.
SPECIAL RECOGNITION - AWARDS AND HONORS
List all awards and special recognition that you have received while attending college.
WORK EXPERIENCE
List all jobs that you have held while attending college.
Employer / Nature of work / Employment dates / Number of hours worked

Signature of applicant: ______Date: ______

If under 18, signature of parent/guardian: ______Date: ______

Send completed applications to: David Sawmiller, C/O Sinclair Community College, 444 West Third Street, Room Number 7311, Dayton, Ohio 45402.

APPLICANTS AWARDED A SCHOLARSHIP WILL BE CONTACTED by a representative of The Montgomery County, Ohio Law Enforcement Officers Memorial Foundation at a number provided in this application form.

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