Families should complete this form when applying for admission.
Please submit form and direct general questions to the Office of Undergraduate Admission • 312.567.3025 • admission@iit.edu
10 West 33rd Street • Perlstein Hall, Room 101 • Chicago, IL 60616 • admission.iit.edu • fax: 312.567.6939
PLEASE PRINT OR TYPE
Student’s Full Name:
Last/Surname _______________________________________________ First Name ____________________________________________ M.I. _______
Home Address: ___________________________________________________________________________________________________________________
City: ________________________________________________________________ State: ____________________ Zip Code: ______________________
Telephone: ____________________________________________________ Email Address: __________________________________________________
Current School: __________________________________________________________________________________________________________________
Entry Term: Fall Spring Year: _______________
Student listed above is:
A child of a member of the Chicago Fire Department
A child of a member of the Chicago Police Department
A grandchild of a member of the Chicago Fire Department
A grandchild of a member of the Chicago Police Department
Parent of Grandparent’s Name: _____________________________________________________________________________________________________
Address: ________________________________________________________________________________________________________________________
City: ________________________________________________________________ State: ____________________ Zip Code: ______________________
Rank: _____________________________________________________ File or Star Number: __________________________________________________
Current House/Office or District/Area Name (or last before retirement): ___________________________________________________________________
Address: ________________________________________________________________________________________________________________________
City: ________________________________________________________________ State: ____________________ Zip Code: ______________________
Supervising Officer (please print name): _______________________________________________ Telephone: __________________________________
Title: ______________________________________________________________ Signature: ___________________________________________________
PLEASE NOTE: If a student earns multiple Illinois Institute of Technology merit scholarships throughout the admission process, the university will
award the highest merit award for which the student is qualified, but will not combine multiple awards. For instance, the Police and Fire Scholarship
may not be combined with a previously awarded Camras, Collens, University, Heald, PTK, Transfer, or International Scholarship.
CHICAGO POLICE AND FIRE DEPARTMENTS
TUITION SCHOLARSHIP
APPLICATION FORM
click to sign
signature
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