The Village of Key Biscayne Public Safety Scholarship to Promote Health and Wellness Application

Personal Information

First Name

Last Name

Phone

Address Line 1

Address Line 2

City

State

Zip

Date of Birth

Citizen of United States of America

Yes

Are you a current employee of the Village of Key Biscayne's Police and/or Fire Departments?

Yes

Are you a former employee of the Village of Key Biscayne's Police and/or Fire Departments with at least 10 years of continuous employment?

Yes

Health or Wellness Hardship

Do you have a documented health or wellness hardship?

Yes

Please use this space to explain health or wellness hardship.

File Attachments

All of the following files are required. If you have difficulties uploading your files, please complete the application and email your attachments to info@keybiscaynefoundation.org

Letter of Recommendation

Choose File

Invoice or Proposal for Needed Care or Treatment

Choose File

Authorized Certification

By certifying and submitting this application, I certify that all of the information reported in this application is true and correct to the best of my knowledge, and further that I understand and agree that if I am awarded this scholarship, it will be payable to the college, as a credit to me, only upon proof of full-time enrollment at the college.