Nate Bruckenthal Memorial Scholarship Application

Applicant Information
Name *
Address *
High School Address *
High School Address
Email unofficial transcripts to Official transcripts will be required if selected for the scholarship.
List all the leadership and officer positions in any organization that you have held along with your single biggest achievement. Include any other areas where you have exhibited leadership.
List any academic, sports, or community honors, award or other special recognition you have received
List any extra-curricular activities or teams such as sports, band, clubs - include level (e.g. Varsity, JV, etc), role on team (e.g. captain, etc) and dates
List community service activities you've participated in within the past 2 years:
Institution of Higher Learning Where You Intend to Enroll
DSF Sponsor Information
Information of the parent or guardian who is sponsoring your application
Sponsor TLE Insignia? *
Is your sponsor authorized to wear the Tactical Law Enforcement Insignia? Please email proof of TLE Insignia authorization (e.g. DD-214, presentation certificate, etc) to
Sponsor Address *
Sponsor Address
Current duty station if active duty or reserve - or indicate if separated or retired.
You must be a dependent of the sponsor to apply
Petty Officer Nathan Bruckenthal gave his life in service to our Nation - How will your personal and/or professional goals honor his sacrifice and contribute to the public good. (500 word limit)
The U.S. Coast Guard's core values are Honor, Respect, and Devotion to Duty - What are your personal core values and why? (500 word limit)
Please provide any additional information you would like to share with the Scholarship Committee (250 word limit).
Submit Application
Confirmation *
I give my word that everything in this application is true and content was created by me.