2019 ESA YOUTH SCHOLARSHIP APPLICATION (NJ)

COMPLETE THIS APPLICATION IF YOU RESIDE IN NEW JERSEY.
  1. { binding displayValue, mode=oneTime }

Student Information

{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{# pageNumbers}

Parent Information

{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{# pageNumbers}

School Details

{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

SAT/ACT Test Scores

Please fill in this section with your SAT and/or ACT scores.
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{# pageNumbers}

Upload Required Documents

{{ Cognito.resources['fileupload-dropzone-message'] }}
{binding Name, mode=oneTime}
{binding Description}
{ binding firstError.message }
Please upload a copy of your most recent high school transcript.
{{ Cognito.resources['fileupload-dropzone-message'] }}
{binding Name, mode=oneTime}
{binding Description}
{ binding firstError.message }
Please upload a copy of your SAT or ACT scores.
{{ Cognito.resources['fileupload-dropzone-message'] }}
{binding Name, mode=oneTime}
{binding Description}
{ binding firstError.message }
Please upload a proof of parent's occupation. A copy of ID or supervisory letter on station letterhead are acceptable.
{{ Cognito.resources['fileupload-dropzone-message'] }}
{binding Name, mode=oneTime}
{binding Description}
{ binding firstError.message }
Please upload proof of acceptance to a college or university. A letter or certificate is acceptable.
{{ Cognito.resources['fileupload-dropzone-message'] }}
{binding Name, mode=oneTime}
{binding Description}
{ binding firstError.message }
Please submit a résumé listing academic prizes, awards, extracurricular activities, outside activities, community service, work history and hobbies.
{{ Cognito.resources['fileupload-dropzone-message'] }}
{binding Name, mode=oneTime}
{binding Description}
{ binding firstError.message }
Please upload a letter of recommendation from a high school counselor, teacher or other outside agency.

For Verified Community Service, please use the Official ESA Youth Scholarship Community Service Forms. 

{{ Cognito.resources['fileupload-dropzone-message'] }}
{binding Name, mode=oneTime}
{binding Description}
{ binding firstError.message }
Complete a 500-1000 word essay which explains “What it means to me to have my parent or guardian involved in securing our community.” Please be original, creative and use proper spelling, grammar and punctuation. (Only writing samples that are typed will be considered.) The essay should be about you as an individual and how your parent or guardian, being a member of the public safety community, has shaped your character. Be sure to include specific examples of how decisions you’ve made in your life reflect the example he or she has set.
{{ Cognito.resources['fileupload-dropzone-message'] }}
{binding Name, mode=oneTime}
{binding Description}
{ binding firstError.message }
Please fill out and upload the official ESA Youth Scholarship Community Service Form.
{ binding firstError.message }
{# pageNumbers}

Applicants who submit this form and meet the appropriate requirements agree to the following:

  1. All prize winners will be notified in writing.
  2. All applications and writing samples become property of the ESA and its state chapters.
  3. I verify to the best of my knowledge that all of the information contained in this application is accurate and correct. My parent or guardian has signed this application too, verifying the accuracy of the information contained herein.
  4. I agree to the terms and conditions of the ESA Youth Scholarship Program. I authorize the ESA and/or its state chapter to verify all aspects of this application with my high school or the employer of my parent or guardian. I agree to abide by all the terms and conditions of the ESA Youth Scholarship Rules.
Do you understand and agree to the terms listed above?
{ binding firstError.message }
{# pageNumbers}

2019 ESA YOUTH SCHOLARSHIP APPLICATION (NJ)

Student Information

Name
{binding displayValue}
Address
{binding displayValue}
Phone
{binding displayValue}
Email
{binding displayValue}
{ binding firstError.message }

Parent Information

Name
{binding displayValue}
Address
{binding displayValue}
Phone
{binding displayValue}
Email
{binding displayValue}
Precinct or Fire House
{binding displayValue}
Phone
{binding displayValue}
Badge Number
{binding displayValue}
Precinct/Fire House Address
{binding displayValue}
{ binding firstError.message }

School Details

Name of High School
{binding displayValue}
Name of High School Counselor
{binding displayValue}
High School Address
{binding displayValue}
Phone
{binding displayValue}
HS Graduation (MM/YY)
{binding displayValue}
Unweighted GPA
{binding displayValue}
Class Ranking
{binding displayValue}
{ binding firstError.message }

SAT/ACT Test Scores

Please fill in this section with your SAT and/or ACT scores.
SAT Verbal
{binding displayValue}
SAT Writing
{binding displayValue}
SAT Math
{binding displayValue}
SAT Total
{binding displayValue}
ACT Composite
{binding displayValue}
{ binding firstError.message }

Upload Required Documents

High School Transcripts
{{ Cognito.resources['fileupload-dropzone-message'] }}
{binding Name, mode=oneTime}
{binding Description}
SAT/ACT Scores
{{ Cognito.resources['fileupload-dropzone-message'] }}
{binding Name, mode=oneTime}
{binding Description}
Parent Occupation
{{ Cognito.resources['fileupload-dropzone-message'] }}
{binding Name, mode=oneTime}
{binding Description}
College Acceptance Letter
{{ Cognito.resources['fileupload-dropzone-message'] }}
{binding Name, mode=oneTime}
{binding Description}
Resume
{{ Cognito.resources['fileupload-dropzone-message'] }}
{binding Name, mode=oneTime}
{binding Description}
Letter of Recommendation
{{ Cognito.resources['fileupload-dropzone-message'] }}
{binding Name, mode=oneTime}
{binding Description}

For Verified Community Service, please use the Official ESA Youth Scholarship Community Service Forms. 

Essay
{{ Cognito.resources['fileupload-dropzone-message'] }}
{binding Name, mode=oneTime}
{binding Description}
Verified Community Service
{{ Cognito.resources['fileupload-dropzone-message'] }}
{binding Name, mode=oneTime}
{binding Description}
{ binding firstError.message }

Applicants who submit this form and meet the appropriate requirements agree to the following:

  1. All prize winners will be notified in writing.
  2. All applications and writing samples become property of the ESA and its state chapters.
  3. I verify to the best of my knowledge that all of the information contained in this application is accurate and correct. My parent or guardian has signed this application too, verifying the accuracy of the information contained herein.
  4. I agree to the terms and conditions of the ESA Youth Scholarship Program. I authorize the ESA and/or its state chapter to verify all aspects of this application with my high school or the employer of my parent or guardian. I agree to abide by all the terms and conditions of the ESA Youth Scholarship Rules.
Do you understand and agree to the terms listed above?
{binding displayValue}

Your progress has been saved.

{ binding firstError.message }
The email has been sent.

2019 ESA YOUTH SCHOLARSHIP APPLICATION (NJ)

COMPLETE THIS APPLICATION IF YOU RESIDE IN NEW JERSEY.

Student Information

Name
{binding displayValue}
Address
{binding displayValue}
Phone
{binding displayValue}
Email
{binding displayValue}
{ binding firstError.message }

Parent Information

Name
{binding displayValue}
Address
{binding displayValue}
Phone
{binding displayValue}
Email
{binding displayValue}
Precinct or Fire House
{binding displayValue}
Phone
{binding displayValue}
Badge Number
{binding displayValue}
Precinct/Fire House Address
{binding displayValue}
{ binding firstError.message }

School Details

Name of High School
{binding displayValue}
Name of High School Counselor
{binding displayValue}
High School Address
{binding displayValue}
Phone
{binding displayValue}
HS Graduation (MM/YY)
{binding displayValue}
Unweighted GPA
{binding displayValue}
Class Ranking
{binding displayValue}
{ binding firstError.message }

SAT/ACT Test Scores

Please fill in this section with your SAT and/or ACT scores.
SAT Verbal
{binding displayValue}
SAT Writing
{binding displayValue}
SAT Math
{binding displayValue}
SAT Total
{binding displayValue}
ACT Composite
{binding displayValue}
{ binding firstError.message }

Upload Required Documents

High School Transcripts
{{ Cognito.resources['fileupload-dropzone-message'] }}
{binding Name, mode=oneTime}
{binding Description}
SAT/ACT Scores
{{ Cognito.resources['fileupload-dropzone-message'] }}
{binding Name, mode=oneTime}
{binding Description}
Parent Occupation
{{ Cognito.resources['fileupload-dropzone-message'] }}
{binding Name, mode=oneTime}
{binding Description}
College Acceptance Letter
{{ Cognito.resources['fileupload-dropzone-message'] }}
{binding Name, mode=oneTime}
{binding Description}
Resume
{{ Cognito.resources['fileupload-dropzone-message'] }}
{binding Name, mode=oneTime}
{binding Description}
Letter of Recommendation
{{ Cognito.resources['fileupload-dropzone-message'] }}
{binding Name, mode=oneTime}
{binding Description}

For Verified Community Service, please use the Official ESA Youth Scholarship Community Service Forms. 

Essay
{{ Cognito.resources['fileupload-dropzone-message'] }}
{binding Name, mode=oneTime}
{binding Description}
Verified Community Service
{{ Cognito.resources['fileupload-dropzone-message'] }}
{binding Name, mode=oneTime}
{binding Description}
{ binding firstError.message }

Applicants who submit this form and meet the appropriate requirements agree to the following:

  1. All prize winners will be notified in writing.
  2. All applications and writing samples become property of the ESA and its state chapters.
  3. I verify to the best of my knowledge that all of the information contained in this application is accurate and correct. My parent or guardian has signed this application too, verifying the accuracy of the information contained herein.
  4. I agree to the terms and conditions of the ESA Youth Scholarship Program. I authorize the ESA and/or its state chapter to verify all aspects of this application with my high school or the employer of my parent or guardian. I agree to abide by all the terms and conditions of the ESA Youth Scholarship Rules.
Do you understand and agree to the terms listed above?
{binding displayValue}