Morgan State University Edward T. Conroy Memorial Scholarship Program Application
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- Marvin Morris
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1 Mrgan State University Edward T. Cnry Memrial Schlarship Prgram Applicatin Imprtant Ntice: Please make sure that yu meet the eligibility requirements belw befre yu cmplete and submit yur applicatin ELIGIBILITY REQUIREMENTS Yu must be a Maryland resident at the time f the applicatin. Yu must enrll at a tw-year r fur-year Maryland cllege r university, as a full-time r part-time, degree-seeking undergraduate r graduate student r attend a private career schl. Yu must be: the sn, daughter, r the surviving spuse (wh has nt remarried) f a member f the United States Armed Frces wh died as a result f military service r wh suffered a service-cnnected 100% permanent disability as result f military service; a veteran wh suffers a service-cnnected disability f 25% r greater, as a result f military service, and has exhausted r is n lnger eligible fr federal veterans educatinal benefits; the sn, daughter, r surviving spuse f a victim f the September 11, 2001 terrrist attacks wh died as a result f the attacks n the Wrld Trade Center in New Yrk City, the attack n the Pentagn in Virginia, r the crash f United Airlines Flight 93 in Pennsylvania; a POW/MIA f the Vietnam Cnflict r his/her sn r daughter and was a resident f this State at the time the persn was declared t be a prisner f war r missing in actin; the sn, daughter r surviving spuse (wh has nt remarried) f a state r lcal public safety emplyee r vlunteer wh died in the line f duty r wh was 100 percent disabled in the line f duty; r a state r lcal public safety emplyee r vlunteer wh was 100 percent disabled in the line f duty; a veteran, as defined under f the State Gvernment Article, Anntated Cde f Maryland, wh either suffers a service cnnected disability f 25% r greater and has exhausted r is n lnger eligible fr federal veterans educatinal benefits; the sn, daughter, r surviving spuse (wh has nt remarried) f a schl emplyee wh, as a result f an act f vilence either died in the line f duty r sustained an injury in the line f duty that rendered the schl emplyee 100% disabled.
2 Cmplete and return this frm by July 15, SECTION A - Applicant Infrmatin: (Please Print) 1. Scial Security Number: - - Date f birth: / / 2. Last name: First name: MI: Previus name under which recrds may be kept: 3. Permanent mailing address: City: State: Zip cde: 4. Hme phne: Wrk phne: 5. address: 6. Are yu a Maryland resident? Yes N 7. Have yu applied fr this schlarship in the past? Yes N Year applied: 8. Has smene else in yur family received this schlarship? Yes N 9. Name(s) f persn(s) in yur family wh has/have received this schlarship: 10. Are yu eligible fr the prgram because yu are a sn, daughter, r surviving spuse f a victim f the September 11, 2001 terrrist attacks (deceased died as a result f the attacks n the Wrld Trade Center, the Pentagn r the crash f United Airlines Flight #93)? Yes N SECTION B - Current Cllege/University Infrmatin: 1. Cmplete name f the Maryland institutin yu will attend in academic year: 2. Degree sught: Undergraduate Graduate Anticipated date f graduatin: / / 3. In Fall semester 2018, I will enrll fr: (please put a numeric amunt in the space prvided belw) # f credits full-time (12+ credits per semester fr undergraduate; 9+ credits per semester fr graduate student) # f credits part-time (6-11 credits per semester fr undergraduate; 6-8 credits per semester fr graduate student) 4. In Spring semester 2019, I will enrll fr: # f credits full-time (12+ credits per semester fr undergraduate; 9+ credits per semester fr graduate student) # f credits part-time (6-11 credits per semester fr undergraduate; 6-8 credits per semester fr graduate student) (Over, please)
3 SECTION C - Family Infrmatin: The fllwing infrmatin pertains t the family member wh was killed as a result f military service in the United States armed frces; r, as a result f service as a State r lcal public safety emplyee r vlunteer; r wh suffered a service cnnected 100% permanent disability as a result f military service; r, was a victim f the September 11, 2001 terrrist attacks. 1. Scial Security Number f persn killed r disabled: Last name f persn killed r disabled: First name: MI: 3. Relatinship f applicant t persn killed r disabled: 4. Branch f United States armed frces r name f public safety facility in which persn killed r disabled served, if applicable: 5. Date f death r disability: / / 6. Address at date f death/disability: City: State: Zip cde: 7. Are yu eligible fr the prgram because yu r yur parent was a POW/MIA f the Vietnam Cnflict? Yes N 8. Are yu currently receiving any ther student financial aid funds because yu are the child r spuse f a victim f the September 11, 2001 terrrist attack? Yes N If yes, please list schlarship name(s) and amunt(s): $ $ SECTION D (If applicable): In the case f 100 percent disabled r deceased military persnnel, and in the case f 25 percent (r mre) disabled military persnnel, please address the fllwing questins. Using a separate sheet f paper, explain the circumstances f the death r disability, the cause, and why it is cnsidered service cnnected. SECTION E - Pledge t Remain Drug Free and Certificatin: As a cnditin f receiving a Maryland State schlarship r grant, I pledge t remain drug free fr the full term f the award. Unlawful use f drugs and alchl may endanger my enrllment in a Maryland cllege as well as my Maryland financial aid award. I certify that the infrmatin given n this frm is true and cmplete t the best f my knwledge. Signature f applicant Date Infrmatin Release Authrizatin: Disabled applicant/parent must sign the fllwing authrizatin statement: I, d hereby cnsent t the release f the requested Print full name f disabled persn infrmatin by the Veterans' Administratin r the State r lcal public safety persnnel ffice t the Office f Student Financial Assistance. Disabled persn's signature Date
4 SECTION G - T be cmpleted by the Veterans' Administratin r the State r lcal public safety persnnel ffice. In the case f 100 percent disabled military persnnel: Cde(s): (name f disabled persn) has a 100 percent* disability rating, and his/her diagnstic cdes are: Percentage(s): *Veterans must be classified as 100% disabled (i.e., cannt be 90% disabled, but 100% unemplyable). In the case f 25 percent (r mre) disabled military persnnel: Cde(s): (name f disabled persn) has a 25 percent (r mre) disability rating, and his/her diagnstic cdes are: Percentage(s): This persn has exhausted his/her federal veterans educatinal benefits. This persn is n lnger eligible fr federal veterans educatinal benefits. In the case f deceased r 100 percent disabled public safety emplyees r vlunteers: Please briefly explain hw the death r disability f r lcal public safety service: (name f deceased r disabled) was classified as a result f State This ffice is unable t prvide the requested infrmatin. I hereby certify that the infrmatin prvided n this applicatin is crrect and cntained in ur recrds. Print name f authrized fficial Signature Title Address Phne number City State Zip cde Date SECTION H - Required Dcumentatin N applicatin will be cnsidered withut the fllwing materials: Cmpleted applicatin fr the academic year. Make sure yu have cmpleted all necessary sectins. Cpy f yur birth certificate shwing names f bth parents if yu are the sn r daughter f a deceased r 100 percent disabled military persn, POW/MIA f the Vietnam Cnflict, deceased public safety emplyee r vlunteer, r deceased victim f the September 11, 2001 terrrist attacks. Cpies may be btained frm the State Department f Vital Recrds. Cpy f yur marriage certificate (if spuse f deceased public safety emplyee r vlunteer r f deceased victim f the September 11, 2001 terrrist attacks).
5 Cpy f death certificate. Verificatin that yu are 25 percent disabled frm a service cnnected disability as a result f military service and have exhausted r are n lnger eligible fr federal veterans educatinal benefits. (Sectin G required.) Verificatin that death as a result f military service, r that death r 100 percent disability was in the line f duty fr a public safety emplyee r vlunteer. (Sectin C and Sectin G required.) Verificatin that 100 percent disability was frm a service cnnected disability as a result f military service. (Sectin C and Sectin G required. Nte: A cpy f the disabled veteran s award letter may be filed instead f Sectin G). A letter stating the cause r reasn fr disability. NOTE: D nt send riginal certificate(s); they cannt be returned. Initial applicants are awarded based upn the pstmarked date a cmplete applicatin was received. NOTE: Awards are subject t the availability f funds. Applicatin must be received by July 15, 2018 at: Mrgan State University Office f Financial Aid Attentin: Edward T. Cnry Memrial Schlarship Prgram 1700 E. Cldspring Lane Baltimre, MD 21251
Edward T. Conroy Memorial Scholarship
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