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RETIRED POLICE ASSOCIATION
OF THE
STATE OF NEW YORK, INC
2003-2004
MEMORIAL SCHOLARSHIP APPLICATION
Please Print
Applicant's Name: ______________________________________age: ____________
Home Address: ________________________________________________________
_____________________________________ Telephone: (_____)________________
Present school attending: _________________________________________________
College/School address: __________________________________________________
That applicant will attend:__________ College/school year: 1____ 2____ 3____ 4____
RPA Sponsor:_________________________________ Phone:__________________
ADDRESS: ___________________________________________________________
Relationship to applicant:_______________Widow of member? _________________
If widow, deceased members full name and date of death:______________________
APPLICATION MUST BE MADE ON THIS FORM, OR IF MORE THAN ONE
ENTRY IN FAMILY, ON AN EXACT MACHINE DUPLICATE IN SIZE AND
CONTENT. MORE THAN ONE ENTRY IN THE SAME APPLICANT'S NAME
OR ENTRIES NOT CONFORMING TO THE REQUIRED SIZE AND CONTENT
WILL BE DISCARDED
RETURN APPLICATION TO:
RETIRED POLICE ASSOCIATION
OF THE STATE OF NEW YORK
1 OLD COUNTRY ROAD, suite 265
CARLE PLACE,NY 11514-1881
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