Sponsored by

New York Corrections and Youth Services Association



Name:                                                                                                  Date:

Home Address:                                                                                 Home Phone:

Work Address:                                                                                  Work Phone:

E-Mail Address:                               


Please provide details regarding your intended use of this scholarship.  If you are requesting consideration for credit bearing courses, please provide details regarding the institution with which you are matriculated. If you are requesting consideration for conference or training purposes, please provide all details, including dates, title, and sponsoring organization. Provide supporting documents, such as transcripts/acceptance letters/conference brochures.


Please also tell us why attending this line of study or training is important to you.





Please tell us a little about yourself, and why you are the best candidate for this scholarship.





Please have two Letters of Reference sent to the scholarship committee on your behalf. Indicate below who we should expect to be hearing from:


Reference #1:    Name:                                                                  Phone:               

Reference #2:    Name:                                                                   Phone: 


Send completed form to:    Joe Behson

                                          39 Summit Drive

                                          Averill Park, New York 12018


Applications are due by July 15, 2018!