Foundation of the 1st Cavalry Division Association
Application for Registration for Scholarship Benefits

This application is for registration of descendants of the following named soldier, a veteran of service with the 1st Cavalry Division, for 1st Cavalry Division Association scholarship benefits:

NAME OF SOLDIER:  ____________________________________________________

UNIT AND DATES WHEN ASSIGNED TO THE DIV: ___________________________  

DATE OF DEATH OR PERCENT OF DISABILITY: _____________________________

_____I certify that I am the widow of the above named soldier. The persons named below are his children. Copies of their Birth Certificates, a copy of his Casualty Report, documentation of his assignment to the 1st Cavalry Division at the time of his death and documentation of his membership in the 1st Cavalry Division Association, if death occurred in peacetime, are attached.
                                                                                OR
_____I certify that I am totally and permanently (100%) disabled, to the extent of preventing me from performing any work for substantial compensation or profit, as a result of wounds received or disease contracted while I served with the 1st Cavalry Division in ___the Vietnam War  ___ Desert Storm   ___ Iraqi Freedom (Check one). The persons named below are my children. Copies of their Birth Certificates with parentage, documentation of my assignment to the 1st Cavalry Division, documentation of my membership in the 1st Cavalry Division Association, documentation of my disability in the degree shown above and proof that the disability resulted from wartime service with the 1st Cavalry Division are attached.                                                                              

NAME(S) AND ADDRESS OF CHILD(REN) OR GRANDCHILD(REN): (Use a separate sheet for additional persons.)  PLEASE PRINT

1._________________________________________________________________________________  

2. _________________________________________________________________________________  

3. _________________________________________________________________________________  

I understand that I will receive confirmation of registration for each eligible child/grandchild and that I must keep the Foundation informed of each child/grandchild's current address, that each registered child/grandchild must make application for a scholarship grant upon acceptance at a recognized institution of higher education, and that eligibility based on disability must be re-validated at the time of application. Application forms are available from the Foundation.  

SIGNED: ____________________________________________

NAME: _______________________________________________                        

ADDRESS: _____________________________________________________________________

CITY: ______________________________________ST: ______ZIP: _________________

PHONE: _________________________  E-mail:  _______________________________________