Executive Offices, 2697 Hamburg Street, Schenectady, NY 12303-3783 • 518-355-3371
Fax 518-356-5767 • Email nysacop@nycap.rr.com
1. Name:_______________________________________________________Age________________
2. Address:_________________________________________________________________________
3. School presently attending: _________________________________________________________
4. Educational Program planned: _____4 year ____2 year ____Other
5. What recognized College or University do you plan to attend? (Correspondence school courses ARE NOT eligible)________________________________________________________________
6. What are your vocational plans? _____________________________________________________
7. You must be eligible as either the daughter, son, granddaughter, grandson or spouse of Active, Active Retired, deceased Active/deceased Active Retired Member of the NYSACOP. Active members and Active Retired members are also eligible. List the name of present or former department of the member of our Association who makes you eligible for consideration.
Eligible Sponsor: ___________________________________________________________________
Relationship to Applicant: ____________________________________________________________
Department/Station (Present/Former___________________________________________________
Date joined the NYSACOP____________________________________________________________
8. Fathers Occupation: _________________________________________________________________
Mothers Occupation: ________________________________________________________________
9. Total number of school age children in your family living at home, including yourself _________
10. Specify other sources of financial assistance that you have obtained.________________________
__________________________________________________________________________________
11. Are you a previous NYSACOP Scholarship winner?
_____Yes What year? ______ ______No
12. Please attach a one page essay which discusses your educational and career
goals and
objectives. This essay also should include the qualities and qualifications
you possess which you believe qualifies you to receive assistance from this
Association.
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