Sorry, but we are no longer accepting submissions for the 2019 ESA Scholarship Program (NJ).

2019 ESA YOUTH SCHOLARSHIP APPLICATION (NJ)

COMPLETE THIS APPLICATION IF YOU RESIDE IN NEW JERSEY.
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Student Information

Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Parent Information

Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Precinct/Fire House Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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School Details

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Name of High School Counselor {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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High School Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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SAT/ACT Test Scores

Please fill in this section with your SAT and/or ACT scores.
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Upload Required Documents

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Please upload a copy of your most recent high school transcript.
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Please upload a copy of your SAT or ACT scores.
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Please upload a proof of parent's occupation. A copy of ID or supervisory letter on station letterhead are acceptable.
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Please upload proof of acceptance to a college or university. A letter or certificate is acceptable.
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Please submit a résumé listing academic prizes, awards, extracurricular activities, outside activities, community service, work history and hobbies.
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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. 

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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.
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Please fill out and upload the official ESA Youth Scholarship Community Service Form.
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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? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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2019 ESA YOUTH SCHOLARSHIP APPLICATION (NJ)

Student Information

Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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{ binding firstError.message }
Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Parent Information

Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Precinct or Fire House {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Badge Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Precinct/Fire House Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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School Details

Name of High School {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Name of High School Counselor {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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High School Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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HS Graduation (MM/YY) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Unweighted GPA {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Class Ranking {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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SAT/ACT Test Scores

SAT Verbal {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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SAT Writing {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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SAT Math {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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SAT Total {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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ACT Composite {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Upload Required Documents

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

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

Essay {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{{ Cognito.resources['fileupload-dropzone-message'] }}
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Verified Community Service {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{{ Cognito.resources['fileupload-dropzone-message'] }}
{binding Name, mode=oneTime}
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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? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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The email has been sent.

Your progress has been saved.

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2019 ESA YOUTH SCHOLARSHIP APPLICATION (NJ)

COMPLETE THIS APPLICATION IF YOU RESIDE IN NEW JERSEY.

Student Information

Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Parent Information

Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Precinct or Fire House {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Badge Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Precinct/Fire House Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }

School Details

Name of High School {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Name of High School Counselor {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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High School Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
HS Graduation (MM/YY) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Unweighted GPA {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Class Ranking {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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SAT/ACT Test Scores

SAT Verbal {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
SAT Writing {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
SAT Math {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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SAT Total {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
ACT Composite {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }

Upload Required Documents

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

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

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