CHP 11-99 Foundation Fallen Hero Scholarship Application 2019-20
This application is exclusively for sons, daughters and widows of California Highway Patrol officers who were killed in the line of duty. If you are unsure if you qualify or not, please email scholarship@chp11-99.org.

To apply for the General Program go to www.chp11-99.org/apply.

Email address *
First name *
Your answer
Middle Name
Your answer
Last name *
Your answer
Birthdate *
MM
/
DD
/
YYYY
Gender *
Ethnicity *
Phone *
Your answer
Phone Type *
Permanent Mailing Address Lines *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Full Name of Fallen Officer *
(parent or spouse who was killed in the line of duty)
Your answer
Relationship to Fallen Officer *
Hometown City (in CA) *
Your answer
Hometown County *
Intended School/Institution Name *
Your answer
Type *
School/Institution Code *
(typically 6 digits) If you do not know your school's code, you may look it up in the Federal School Code Search on the FAFSA web site at https://fafsa.ed.gov
Your answer
School/Institution City *
Your answer
School/Institution State *
Your answer
Which best identifies the general field of study you plan to pursue? *
Academic Status for 2019-20 Year *
Cumulative GPA (must be 2.7 or higher to qualify unless attending a trade/technical/vocational school) *
Your answer
Estimated Total Tuition Cost for year (Fall '19-Summer '20) *
Your answer
Estimated Total On-Campus Housing Cost for year (Fall '19 - Summer '20) *
Your answer
Estimated Total Books & Fees Cost for year (Fall '19 - Summer '20) *
Your answer
Official Transcript *
Please order an Official Transcript for the most recent academic institution you attended. Must be received no later than April 15, 2019 via mail or digital service.
Required
Transcript Format/Method of Delivery *
ESSAY - Why are you pursuing your education, and what do you plan to do with it? *
Your narrative should be a well-constructed essay, using proper grammar and punctuation. (250-500 words please)
Your answer
YouTube/Vimeo Introduction Video *
Please create an introductory video of yourself for the Scholarship Committee. The video should NOT be professional or post-produced/edited. An amateur, 60-second video taken on a smart phone or laptop camera will be sufficient. Save the link to be pasted below here. Must be YouTube or Vimeo only.
Your answer
Deadline to submit this form is March 15, 2019
If you have any questions, please email scholarship@chp11-99.org
A copy of your responses will be emailed to the address you provided.
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