CAFOP Scholarship Application

CALIFORNIA STATE LODGE
FRATERNAL ORDER OF POLICE
P.O. BOX 6919
Buena Park, California 90621-6919

SCHOLARSHIP APPLICATION

Date___________________

Name_________________________________ Date of Birth_______________________

Address________________________________ Phone No. _______________________

Name and relationship of police officer member of Fraternal Order of Police____________________

____________________________ Lodge Name and Number ________________________

Name of parents or guardians with whom you are living:

Father _________________ Mother _________________Other _________________

Father's Occupation ____________________________________________________

Mother's Occupation ___________________________________________________

Your health status ____________________________ If not good, please explain

_______________________________________________________________

Do you plan to be employed? _______ If yes, hours per week ________________

Type of work ______________________________________________________

List school activities in which you were or are active in. List any elected offices you
hold or held.

Activity	Year	Office Held	Year
_______________	_______________	_______________	_______________
_______________	_______________	_______________	_______________
_______________	_______________	_______________	_______________

List off-campus activities, length of time and degree of activity (volunteer, civic, church,
scouts, hospital, etc.)

Organization		Time / Involvement
_________________________________		_________________________________
_________________________________		_________________________________
_________________________________		_________________________________

List any awards or honors received _____________________________________

________________________________________________________________

List any hobbies and other interests _____________________________________

________________________________________________________________

List work experience:

Business Name	Job Title	Date From - To
______________________	______________________	______________________
______________________	______________________	______________________
______________________	______________________	______________________

College / Trade / Business School Choices

1. __________________________________________________________________________

2. __________________________________________________________________________

3. __________________________________________________________________________

Have you been accepted? Yes _______ No _______

If yes, please provide proof of enrollment.

Intended Major _________________________________________________

Intended Career ________________________________________________

Junior High	High School	GPA
_____________________	_____________________	_____________________
College	Trade/Business School	GPA
_____________________	_____________________	_____________________

Date you took or plan to take the S.A.T. _______________

Date you took or plan to take the A.C.T. _______________

Date(s) you took achievement tests (If applying to the university
of California system or others requiring these tests.)_______________________

_________________________________________________________________

In the space below, write a statement indicating why you feel you are deserving
of a scholarship / grant. (Must be completed. Attach additional pages, if needed.)

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*** Include a photo of yourself ***

PARENTS CONFIDENTIAL FINANCIAL STATEMENT

Total number od dependents __________
Last year's adjusted gross income ( 1040 or 1040A )		__________
	Social Security Benefits	__________
	Other (Welfare, child support, rental income, etc.)	__________

Do you expect this year's income to be similar? Yes _____ No _____

If no, please explain:

Do you own or rent your home? Own _____ Rent _____

If you own, what is the current market value? _______________

Unpaid balance of mortgage? (Include second trust deeds, if any) __________

Please list all automobiles in family

MAKE	MODEL	YEAR	VALUE
_______________	_______________	_______________	_______________
_______________	_______________	_______________	_______________
_______________	_______________	_______________	_______________
_______________	_______________	_______________	_______________

Please list any unusual expenses or circumstances, such as prolonged illness,
uninsured losses, indebtedness, etc., which would indicate your financial need.
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________

Are there any other members of the famiy that are in or about to enter college?

Yes _____ No _____

If yes:

NAME	COLLEGE
______________________	___________________________________
______________________	___________________________________
______________________	___________________________________
______________________	___________________________________

Did they receive scholarships or grants? Yes _____ No _____

If yes, in what amount and from where?

The above information in this form is true and correct to the best of my knowledge.

______________________________	______________________________
Father's Signature (Guardian)	Mother's Signature (Guardian)

Mail application to:

California State Lodge
Fraternal Order of Police
P.O. Box 6919
Buena Park, California 90261-6919

ALL APPLICATIONS MUST BE RECEIVED BY THE ANNUAL CUTOFF DATE OF APRIL 1st