Name/s of parent/s or guardian/s__________________________________________________
____________________________________________________________________________

Part II – Educational Data

Name of school currently attending________________________________________________

Address_____________________________________City____________Zip______________

Class you are in currently_______________________________________________________

Name and type of institution you plan to attend ______________________________________

Type of degree/certification do you plan to work toward _______________________________

Grade point average_________(Attach official transcript/s or completed Part  VI certification)

Date and title of honors, academic awards, achievements and recognitions (current and
previous year)_________________________________________________________________

____________________________________________________________________________

Attach letter of recommendation from school official.

Part III – Other Activities (Extracurricular, community, employment)________________

____________________________________________________________________________

Attach letter of recommendation from the head of one of these activities.

Part IV – Essay
Attach an essay of at least 500 words on “Why I want to pursue a career in law enforcement”.
                                                               

Part V – Certifications

            I certify that the information provided in and with this application is accurate. [ I am presently in good health and know of no personal or physical limitation that would prevent my full participation in a career in law enforcement or criminal justice.]  I understand that this scholarship is for tuition and books only and will be paid directly to the institution.  It is the responsibility of the recipient to submit this information to the institution accepting the scholarship funds.  If a student fails to complete the first semester of school, any remaining funds will be sent back to the Chief Bill R. Anderson Memorial Scholarship Fund Committee,  P. O. Box 237, Bastrop, TX 78602.

            If the scholarship committee reviewing the scholarship application wishes to interview the applicant  and/or have the Bastrop Chief of Police or his appointed representative interview the applicant, the applicant will be notified by mail as to the date, time and place of the interview.  A parent or school administrator may also attend.

Applicant Signature___________________________________________Date_____________

Parent or Guardian Signature ___________________________________Date____________         

---

Part VI - Grade Point Certification (In lieu of transcript)

School Administrator or Registrar:  Please complete the following and sign.

Applicant’s grade point average is________________ out of a possible________________

School Name_______________________________________________________________

Address___________________________________________________________________

             ________________________________________Phone Number_______________

Administrator/Registrar Printed Name___________________________________________

Signature_______________________________________________Date_______________