Nassau County Office of Emergency Management

Safer Grant Scholarship Application

NOTE: Full time students must apply for FAFSA and TAP, Part time students need to apply for FAFSA only.

Please fill out the required information below

Personal Information

Red asterisk * denotes a required field.

First Name: *

Last Name: *

Social Security Number: *

Address 1: *

Address 2:

City: *

State: *

Zip Code: *

Day Phone: *

Night Phone:

Email: *

School Information

Red asterisk * denotes a required field.

Are you a new or returning student?

NCC ID: *

Semester: *

Semester Year: *

Program of Study: *

Fire Department Information

Red asterisk * denotes a required field.

Fire Department Name: *

Date Joined:

Name of Authorizing Chief: *

Student Acknowledgement/Certification:

Please read and check each line below.

I certify that I have read the S.A.F.E.R. Administrative Guide.

I understand that I will be responsible for ALL TUITION AND FEES incurred should I not maintain the minimum requirements of the Grant Program as listed in the 2018 SAFER Grant Administrative Guide.

I understand that I am REQUIRED to apply for the tuition assistance from FAFSA and TAP, and I authorize Nassau Community College to share this information with Nassau County OEM.

I have authorized Nassau Community College to share my grades with Nassau County OEM.

I understand that I am REQUIRED to schedule an interview with Nassau County OEM, upon which I will provide proof of residency, a currently dated letter of chief’s approval, and proof of SAR submission (student aid report).