SCHOLARSHIP APPLICATION FORM

Community Foundation of Orange and Sullivan/ Firefighters Thomas J. & Daniel R. Foley Memorial Scholarship

IMPORTANT: This form and supporting documentation must be received by the Scholarship
Committee on or before August 15, 2025

Applicant Personal Details

First Name

Last Name

Gender

Male

Female

Prefer not to say

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Birth

YYYY

Social Security Number

Parent or Legal Guardian Employed by FDNY

First Name

Last Name

Gender

Parent's / Guardian's Date of FDNY Appointment

YYYY

Current Assigned Fire House

Previously Assigned Fire House

If no previous firehouse, enter 'N/A'

FDNY Badge Number

Name of Applicant's High School

High School Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Graduation Date

YYYY

Sports Played

If not applicable, enter 'N/A'

Activities

If not applicable, enter 'N/A'

Interests

Name of College/University

College/University Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Expected Admission Date

YYYY

Admission Advisor

First Name

Last Name

Admission Advisor's Phone Number

(###)

###

####

Scholarship Submission Digital Signature

Enter your first and last name as a digital signature

First Name

Last Name

SCHOLARSHIP APPLICATION FORM

FOLEY STRONG