Scholarship Application

The 100 Club provides Scholarships of Excellence of up to $2,000 to high school seniors and full time college students who are the children of, or are themselves active law enforcement, fire or emergency service providers who plan to continue their education at a college level.

100 Club of Buffalo - Scholarship of Excellence Application

You must be the child of, or you yourself be, an Emergency Responder

Applications must be electronically received by March 31st, 2018!

Personal Information:

First Name: Last Name:
   
Address:
           
City: State: Zip:
   
Phone:
   
E-Mail
 

Education:

High school or college currently attending:
Cumulative GPA in current educational institution as of 12/31/2017
Highest college entrance exam scores: SAT MATH
Highest college entrance exam scores: SAT READING
Highest college entrance exam scores: SAT WRITTEN
Highest college entrance exam scores: ACT
 

Collegiate Plans:

Name of college or university most likely to attend for 2018/2019
Have you applied to the school?
Have you been accepted?
Anticipated type of degree and major at graduation
How many credits per semester anticipated in 2018/2019?
   
What are your career plans after completing your collegiate education?
(75 words or less)
   

Employment:

Are you or have you been employed: Yes No
Explain your work situation: (explain in 100 words or less)

First Responder Eligibility:

Who is the First Responder?
If family member, name and relationship to applicant:
First Responder’s public service agency affiliation
Is the First Responder currently active in the agency?
First Responder’s immediate supervisor’s name:
First Responder’s immediate supervisor’s phone:
How many years of active service has the First Responder served?
Have you considered future participation as a First Responder as a police officer, firefighter or EMT? (explain in 100 words or less)
 

Community Service/Extra Curricular Activities:

Criteria for consideration: outstanding achievement in academics, extracurricular or employment activities and community involvement.
(Describe in 350 words or less)

 


“By submitting this document I represent that I, the scholarship applicant, have personally completed this application and all submitted information is truthful. I understand that verification of all information may be required prior to receiving any funds. Failure to adhere to such may result in disqualification of your application”

Incomplete applications may result in the disqualification of the applicant. The 100 Club of Buffalo decisions are final and the organization is not responsible for lost or misdirected applications.

Applications must be electronically received by March 31st, 2018.