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Home
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NAEMT Foundation
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Foundation Scholarships
/
Scholarship Application
Foundation Scholarship Application
Complete the application below to apply for a scholarship to become an Emergency Medical Responder (EMR) or Emergency Medical Technician (EMT).
Foundation Scholarship Application
Applicant First Name
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Applicant Last Name
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Street Address
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City
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State
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Zip
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Home Phone
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Daytime Phone
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Email Address
*
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Marital Status
*
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Number of Dependents
*
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Education
Check the highest grade completed
9th Grade
10th Grade
11th Grade
12th Grade
GED
1 Year of College
2 Years of College
3 Years of College
4 Years of College
More than 4 years of College
Employment Information
Current Employer
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Street Address
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City, State, Zip
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Phone
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Hire Date
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Contact Person
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Position
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Your Spouse's Employer
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Spouse's Position
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Other Employment History (previous five years)
Employer
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Position
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From (Date)
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To (Date)
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Employer
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Position
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From (Date)
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To (Date)
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Employer
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Position
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From (Date)
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To (Date)
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Employer
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Position
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From (Date)
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To (Date)
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Employer
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Position
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From (Date)
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To (Date)
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List affiliation with EMS organization(s), if applicable
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EDUCATIONAL INSTITUTION
What EMS program or school do you plan to attend?
Name
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Address
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City
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State
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Zip
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Phone
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Website
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Are you currently enrolled?
Yes
No
In which term will you begin your EMS program?
Fall
Winter
Spring
Summer
What is the cost for the EMS program you will attend?
Tuition
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Books
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Other fees
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At which EMS service do you plan to work upon completion of this EMS program?
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APPLICANT’S FINANCIAL STATEMENT
(Use previous year’s tax returns and W2 forms)
Your Annual Gross Income
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Spouse's Annual Gross Income
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Total Household Income
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NARRATIVE
In 1,000 words or less, please describe why you are pursuing this educational scholarship and how it will benefit you. The criteria below will be used in the selection process and should be addressed in your narrative:
Commitment to entering the EMS profession;
Financial need;
Dedication to the community;
Ability to serve as a positive ambassador to the EMS profession
NARRATIVE
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AFFIDAVIT
By submission of this application for a NAEMT Foundation Scholarship, I hereby certify that the information contained herein is true and correct and I grant NAEMT Foundation permission to verify any and all information I have provided. If I receive an NAEMT Foundation scholarship, I commit to seek certification in the state in which I reside or with the NREMT upon completion of this program.
Check box if you agree
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I Agree
Name of Applicant
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