Professional Firefighters and Paramedics Benevolent Fund, Inc.
2328 South Congress Avenue, Suite 2C
West Palm Beach, Florida 33406-7874
Dear Applicant,
Thank you for applying for the Jeff Annas Memorial Scholarship. The Professional Firefighters/Paramedics Benevolent Fund, Inc. will
be awarding multiple scholarships ranging from $1000- $2000 to assist local high school seniors in pursuing their college education.
Payment will be made directly to a qualified educational institution once the student is enrolled.
The following guidelines must be adhered to in order to qualify:
1. The applicant must be graduating from a public, private, or home school program within Palm Beach County and entering
college as a full-time student. (Benevolent Fund Members do not need to reside in Palm Beach County)
2. You must have a cumulative GPA (not HPA) of at least 2.50.
3. A copy of your parent’s or guardian’s 2016 tax return must be included. If the 2016 tax return is unavailable, attach a copy of
the 2015 tax return and the 2016 W-2 form(s). If parents are divorced or file separately, send tax information of both parents.
(Benevolent Fund Members do not need to supply tax documents)
Please remove or blackout all references to Social Security numbers on the tax forms.
4. Include two (2) letters of recommendation from faculty members (limit to one page each).
5. Your guidance counselor will need to complete the information on the Guidance Counselor Form.
6. Compose and type a five hundred (500) word essay describing: a) your academic goals; b.) your community involvement and
service; and c) what makes you unique or especially deserving of this scholarship award.
7. **NOTE** Applicants for the Dalero and the Fire Chiefs Association Scholarship can be previous graduates of High
School. Therefore the only information needed is: Your own tax return if over 18, the 500 word essay, and two letters of
recommendation from anyone you deem appropriate.
APPLICATION DEADLINE: All applications must be received at the following address or be postmarked by
Friday March 31st, 2017. Applications postmarked after this date will not be eligible for consideration.
Mail your application to: Professional Firefighters and Paramedics Benevolent Fund, Inc.2328 South Congress
Avenue-Suite 2CWest Palm Beach, Florida 33406-7874Attention: Richard Ellis – Jeff Annas Memorial
Scholarship. If you have any questions, please contact Richard Ellis at 561-512-5134.
Professional Firefighters and Paramedics Benevolent Fund, Inc. is a non -profit 501(C)3 organization.
A COPY OF THE OFFICIAL REGISTRATION (#CH22508) AND FINANCIAL INFORMATION MAY BE OBTAINED FROM THE DIVISION OF CONSUMER SERVICES BY
CALLING TOLL-FREE (800-435-7352) WITHIN THE STATE. REGISTRATION DOES NOT IMPLY ENDORSEMENT, APPROVAL, OR RECOMMENDATION BY THE STATE.
2017 Jeff Annas Memorial Scholarship Student Application
Complete each item. Please type or print in black ink.
THIS SECTION TO BE FILLED OUT BY STUDENT APPLICANT ONLY
Name ___________________________________________________________________________________________________
Last
First
Middle Initial
Home Address ____________________________________________________________________________________________
Street
City/State
Zip
Telephone Number ________________________________________________________________________________________
Home
Work
Cell
Date of Birth (MM/DD/YY) _______________________
High School Presently Attending ______________________________________________________________________________
Extra Curricular Activities, Honor, Awards, Positions of Leadership: (use additional sheets if necessary) ______________________
__________________________________________________________________________________________________________
College/University you plan to attend ___________________________________________________________________________
Intended Areas of Study ______________________________________________________________________________________
STATEMENT OF APPLICANT
By signing below, the applicant certifies that the information provided is accurate and they have read and understood the conditions of
the Jeff Annas Memorial Scholarship Student Application.
Applicant Signature _________________________________________________________ Date ________________________
Parent/Guardian Signature___________________________________________________ Date ________________________
Father’s Name
__________________________________________________ Marital Status__________________________
Occupation
________________________________________________ Employer________________________________
Mother’s Name
__________________________________________________ Marital Status__________________________
Occupation
________________________________________________ Employer________________________________
Guardian’s Name ___________________________________________________ Marital Status__________________________
Occupation
________________________________________________ Employer________________________________
Indicate figure nearest to the amount of the family gross income for 2016. Include ALL sources of income (e.g., Alimony, Child
Support, Investments, etc.)
_____$0 TO $40,000
_____$60,001 TO $85,000
_____$40,001 TO $50,000
_____$85,001 TO $110,000
_____$50,001 TO $60,000
_____$110 and above
2017 Jeff Annas Memorial Scholarship Student Application
Guidance Counselor Form
Statement from Counselor:
I certify that______________________________________ is a candidate for graduation on___________________
GPA________________________ Number of community service hours__________________________________
Additional Comments: ( attached additional form if needed)
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Counselor’s Signature:___________________________________________________ Date___________________________
2017
Jeff Annas Memorial Scholarship Student Application
Please complete the application and attach all required documentation as listed below.
Jeff Annas Memorial Scholarship Application Checklist
_____ Completed and signed application
______ Cumulative GPA (not HPA) of at least 2.50
______ A copy of parent/guardian’s 2015 tax return Remove all references to Social Security numbers
______ Include two (2) letters of recommendation from faculty members
______ Completed Guidance Counselor form
______ Five hundred (500) word essay