EMT Scholarship Application Form

Applicant Information

Education

Employment

Current Employment

Past Employment

Volunteer Experience

EMT Program Enrollment

Financial Information

Personal Statement

Provide a 500-word essay or a short video, no longer than three minutes, that describes why you want to serve your community as an Emergency Medical Technician (EMT). Please use this opportunity to explain your personal motivations, financial need, and career aspirations. The criteria listed below will be used in the selection process and should be addressed in your personal statement:

• Commitment to entering the EMS profession
• Financial need
• Dedication to the community, such as volunteer experience
• Willingness to serve as a positive ambassador to the EMS profession

EMT Scholarship Guidelines

Please read each statement carefully and provide your consent below, confirming that you understand and agree with the EMT Scholarship Guidelines.

• Recipient must begin and fully complete the EMT training program for the term for which the scholarship is granted.
• If the student is ultimately not successful and fails or withdraws from the class, he/she may be eligible to retake the course. However, a decision to offer an additional scholarship award to the student will be at the discretion of the EMT Scholarship Committee.
• Recipient of EMT scholarship must seek certification by testing upon completion of his/her EMT training program.
• Recipient must provide follow-up information and respond to Medic One Foundation requests pertaining to his/her education and career.

Affidavit

By submission of this application for the EMT Scholarship, I hereby certify that the information contained herein is true and correct, and I grant Medic One Foundation permission to verify any and all information I have provided.

My signature is evidence that I have read and agree with the above statement.