STUDENT NAME: ___________________________________________________ STUDENT ID: (700 #) _____________________________
Under this scholarship, beginning with the 2018-2019 award year, a Pell-eligible student whose parent or guardian died in the
line of duty while performing as a public safety officer is eligible to receive a maximum Pell Grant for the award year for which the
determination of eligibility is made. All Title IV aid awarded to such eligible students must be based on an EFC of zero without regard
to the student’s calculated EFC.
To qualify for this scholarship, a student must be Pell-eligible and have a Pell-eligible EFC, and be less than 24 years of age or enrolled
at an institution of higher education at the time of his or her parent’s or guardian’s death. In subsequent award years, the student
continues to be eligible for the scholarship, as long as the student has a Pell-eligible EFC and continues to be an eligible student.
For purposes of the Children of Fallen Heroes Scholarship, a public safety officer is:
As defined in section 1204 of title I of the Omnibus Crime Control and Safe Streets Act of 1968 (42 U.S.C.3796b); or
A fire police officer, defined as an individual who is serving in accordance with State or local law as an officially recognized or
designated member of a legally organized public safety agency and provides scene security or directs traffic in response to any fire
drill, fire call, or other fire, rescue, or police emergency, or at a planned special event.
Date of Birth: / / Date of parent’s/guardian’s death: / / Was under age 24? Yes No
Phone Number: Enrolled in college at time of parent’s/guardian’s death? Yes No
Mailing Address:
City: State: Zip Code:
The Children of Fallen Heroes Scholarship requires the institution’s financial aid administrator (FAA) to determine and document, in
collaboration with the student, that the student was less than 24 years of age or enrolled at an institution of higher education at the
time of his or her parent’s or guardian’s death.
A determination letter acknowledging eligibility for certain federal benefits under the Public Safety OfficersBenefit (PSOB)
program administered by the Department ofJustice;
A written letter of attestation or determination made by a state or local government official with supervisoryor other relevant
oversight authority of an individual who died in the line of duty while serving as a public safety officer as defined above;
Documentation of the student qualifying for a state tuition or other state benefit accorded to the children or other family
members of a public safety officer consistent with the definition in 42U.S.C. 3796b, or as a fire police officer as noted above; or
Other documentation from a credible source that describes or reports the circumstances of the death and the occupation of the
parent or guardian.
I submitted proof of eligibility in a prior year and remain eligible this year.
I certify the above information and attached document(s) are true and correct, and that I qualify for this scholarship.
Student signature:
______________________________________________________________ Date: ________________________________
Financial Aid
1100 North Avenue Grand Junction, CO 81501-3122
800.982.6372 970.248.1396 (o) 970.248.1192 (f)
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