WEMSA Foundation Scholarship Application
2024 - 2025 Academic Year
Name
*
First Name
Last Name
Mobile Phone Number
*
E-mail
*
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Home Address
*
Street Address
Apt/Unit #
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Company
Current EMS Agency or Employer (if applicable)
What Wisconsin Technical College are you enrolled in or will you be enrolled in for the 2024 - 2025 Academic Year?
*
Please Select
Blackhawk Technical College
Chippewa Valley Technical College
Fox Valley Technical College
Gateway Technical College
Gundersen Lutheran EMS Training Center
Lake Country Fire & Rescue Training Center
Lakeshore Technical College
Life Link III Training Center
Madison Area Technical College
Mercy Regional EMS Training Center
Mid-State Technical College
Milwaukee Area Technical College
Milwaukee County EMS Training Center
Milwaukee Fire Department EMS Training Center
Moraine Park Technical College
Nicolet College
Northcentral Technical College
Northeast Technical College
Northwood Technical College
Southwest Wisconsin Technical College
University of Wisconsin Hospital EMS Training Center
Waukesha County Technical College
Western Technical College
Other
Please specify which approved center if not listed above:
What program are you enrolled/enrolling in?
*
Please Select
Emergency Medical Responder (EMR)
Emergency Medical Technician (EMT)
Advanced Emergency Medical Technician (AEMT)
Paramedic Technician
Critical Care Paramedic
Community Paramedic
Fire Medic
Other
Please specify which program if not listed above:
Please submit your current Resume / CV
*
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Please upload a letter of recommendation from a mentor, past supervisor, or colleague. Emphasis will be put on recommendations from current EMS providers or departments.
*
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Please provide a Personal Statement that highlights one or more of the following: your motivation for pursuing a career in EMS, personal experiences that have influenced your decision, and/or how the scholarship will impact your education and future in EMS.
*
The recommended length for the Personal Statement is 100-250 words.
Please provide an Explanation of Need that includes any specific circumstances or challenges that support your request for this scholarship. This information will help us understand your situation.
*
The recommended length for the Explanation of Need is 100-250 words.
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