Suffolk Police Columbia Association
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Scholarship Application
PO BOX 160, YAPHANK, NY 11980
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| Students Name:______________________________________________ |
(Must be a dependant child of member)
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Phone:____________________________
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Home Address:________________________________________________________________
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| Columbia Member Sponsoring Student:______________________________________________ |
(if Active include rank or retired)
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| I have attended:______________________________________________ |
(Name of School)
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and have completed the Spring Semester.
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Signature of applicant:_____________________________________________________
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| Signature of Member:_____________________________________________________ |