Are you attending an in-state college or university & successfully achieve a grade of “C” or above

Yes No

According to your response below, you do not meet the eligibility criteria for applying to this program

Are you attend an in-state college or university & successfully achieve a grade of “C” or above
Are you a police officer or officer employed by Probation and Parole working within the State of Delaware

Officer First Name*

Middle Name

Officer Last Name*

SSN#

FSF# (How to get FSF#)

Date of Birth*

Gender*

Race*

Ethnicity*

LE Agency*

Contact Number*

Email*

Address 1*

Address 2

City*

State*

Zip*

Course Title*

Course Work*

University or College Name*

Semester Taken*

Anticipated Tuition Cost ($)*

City*

State*

Zip*

Note: reimbursement is limited to 2 classes per term for undergraduate work and 1 class per term for graduate work.Semester corresponding to the course taken