Dr. Stephen and Beverly Hoptay Fellowship Application

I certify this and have read, understood, and agree with these criteria and requirements:

Signature*

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First Time or Renewal Application*

First time application Renewal

Name*

First Name

Last Name

NJ State Police (NJSP) ID#*

Date of Birth*

Place of Birth*

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Phone*

Email*

Employer*

Employer Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Employer Phone*

Rank/Title*

Years of Continuous Law Enforcement*

Agencies Worked For and Dates of Employment:*

Current Assignment*

Education*

Additional Comments

I am applying for the:*

Fall Semester Spring Semester

Personal Statement

Please tell us about your leadership and commitment to excellence in law enforcement, initiative, and responsibility to advance the greater good. Describe how this fellowship award is relevant and valuable to your career plans. Your personal statement should provide a better sense of who you are and how you approach life.*

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Campaign Medium

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Campaign Name

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