Nassau County Sheriff's Department Emerald Society

Captain Nancy O'Doherty
Officer Walter DeMorris
Memorial Scholarship Application

Applicants Name________________________________________



Members Name_________________________________________


Grade / Level____________________________________________

1) Member must be a dues paying member in good standing for the TWO preceding years.
       2)Applicant must attend a College, High School, Grammar School, 
or Vocation School, that requires tuition to attend.
3) Applicant must be of the following relationship to the Member.                

A) Spouse                                 
B) Son or Daughter                   
C) Sibling (Brother or Sister)    
D) Grandchildren                       
4) Scholarship must be used for tuition, room and board, or books and
5) Applications must be submitted to a Board Member by June 14th.

I have read the above and do so declare that I meet the  requirements of the
Scholarship Commitee, and that the information on the application is true, and
that the funds will be disbursed in accordance with the requirements.

_________________________                                      _____________________

Applicant's Signature                                                         Members Signature