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Office of the Illinois State Treasurer Bright Start Fallen Heroes Scholarship Program Application – V02252019
Bright Start Fallen Heroes Scholarship Program Application Form
Deadline: This application form (“Form”) and all other required documentation must be submitted
via mail to Office of the Illinois State Treasurer, Fallen Heroes Scholarship, 100 W. Randolph Street, Suite
15-600, Chicago, Illinois 60601 or via electronic mail to FallenHeroes@IllinoisTreasurer.gov
. Applications
must be received via electronic mail or postmarked no later than June 30, 2019. Applications submitted
after June 30, 2019, will be reviewed on a rolling basis based on scholarship availability. All fields and
requested documentation are required. The “Applicant” information requested below is for the intended
beneficiary, unless otherwise noted. Questions may be directed to
FallenHeroes@IllinoisTreasurer.gov or
to (866)465-9724. All capitalized terms used in this Form have the meaning ascribed to them in the
preceding pages or as defined herein.
Applicant’s Name (Last, First):
Applicant’s Date of Birth:
Applicant’s Social Security Number:
Applicant’s Mailing Address:
City: State: Zip Code:
Applicant’s (or Parent/Guardian’s) E-Mail Address:
Applicant’s (or Parent/Guardian’s) Telephone Number:
The following supporting documentation must be submitted contemporaneously with this Application:
□ The birth certificate or adoption certificate of the Applicant clearly stating the name of the Fallen Hero.
In the case of stepchildren, a marriage license clearly stating the name of the Fallen Hero must also be
included.
□ Proof of Illinois residence of Applicant, or parent or legal guardian, as applicable. Acceptable
documentation includes a current Illinois driver’s license, a utility bill issued within 90 days of
application, official mail received from a state, county, city or village, or a Federal Government agency,
or a canceled check or bank statement dated within 90 days prior to application.
□ Official documentation from a Federal agency or an Illinois State or local agency reflecting that the
Applicant’s parent was a Fallen Hero, as defined herein. Acceptable documentation may include
Department of Defense Document DD-1300 or proof of benefits under the Illinois Line of Duty
Compensation Act for the deceased parent.
□ Official documentation from a Federal agency or an Illinois State or local agency reflecting that the
Applicant’s parent was an Illinois resident at the time of death. Acceptable documentation may include
Illinois driver’s license, a utility bill, official mail received from a Federal agency or an Illinois State
or local agency, or a canceled check or bank statement.