Part A - Personal Data

1. Name of Applicant:  ________________________________________

Home:  _____________________________________________

Email Address: _______________ Fax____________________ Home Address: ________________________________________________

City: ____________________State: ___________Zip:__________________

2. Are you employed in the fire service? Yes: __________No:____________

Company Name:  ______________________________________________

Address:  _____________________________________________________

3. Provide an Executive Summary of the Proposal:_____________________

______________________________________________________________

______________________________________________________________

Applicant Signature________________________
Date  ___________________________________

Part B – The Proposal

1. The proposal meets the following criteria. Check only one.

   
   Scholarship Grants

    College  Fire Safe Council Program

    Trade School  Fire Service Public Education

    Vocational Education Courses  Other

    Certificate Training Programs
    

2. Duration and timing of the Project or Scholarship. Be date specific.Beginning __/__/__ Ending __/__/__
    
   
3. Total amount funds requested. $ ______________________

   
   An itemized line item budget shall be submitted with this portion of the application for all Grant Projects and referenced as an Exhibit. This Exhibit is waived for Scholarship Applications.
    

4. Provide a detailed description of how the educational endeavor or project relates to the area of public fire education or how the intended project will safeguard life and property against the ravages of fire and related hazards. Describe why you believe you or your organization is most deserving of this award.