KEMSA Scholarship Form
Scholarship application forms are due by February 15, May 15, August 15 and October 15.
Personal Information
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
KEMSA Membership Number (if applicable)
If spouse, child or grandchild - name of KEMSA member and relationship
Current EMS License
*
None
EMR
EMT
AEMT
Paramedic
Back
Next
Scholarship Information
Requesting Scholarship Dollars For:
*
EMR
EMT
AEMT
Paramedic
Higher Education
Training Program
*
Training program or college address where scholarship money should be sent if awarded:
*
Start date of Program
*
Cost of Program
*
Have you officially enrolled in the program?
Yes
No
Are you currently enrolled in any other related courses?
Yes
No
If yes, what other course(s)?
Other scholarship(s) or financial assistance received:
High School and/or college attended with graduation years if applicable:
Current Employment:
Past Employment:
Do you plan to continue working while taking this training?
Yes
No
Reference #1 - Name, Phone, Email, Relationship
*
Reference #2 - Name, Phone, Email, Relationship
*
Reference #3 - Name, Phone, Email, Relationship
*
Back
Next
Application Requirements
Proof of acceptance into an EMS program
*
Browse Files
Cancel
of
One professional letter of recommendation, i.e. your last instructor or last employer
*
Browse Files
Cancel
of
One page essay (single or double spaced) containing the following: Current and past involvement in EMS, if any; Career goals or future plans in EMS; Community involvement; Why you wish to pursue a specific EMS program; Why you would like a scholarship or financial needs
*
Browse Files
Cancel
of
A 250 word (or less) biography stating information about your previous and/or current EMS experience, a brief account of activities you are involved in, how you got interested in EMS, and goals for the future.
*
Browse Files
Cancel
of
A current high quality digital photo.
*
Browse Files
Cancel
of
Submit
Should be Empty: