Application Instructions for EMT Scholarship
All applications must be submitted before the EMT class begins or no later than one (1) week into the class start date. Please fill out the form completely to the best of your abilities. *Please note, incomplete applications will not be considered.
This application is being filled out for:
*
Please Select
Individual
Cohort
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Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth
-
Month
-
Day
Year
I am a resident of South Carolina
Yes
No
In your own words, why are you seeking a scholarship for EMT certification?
Are you currently enrolled in an EMT class/program?
Yes
No
If yes, what is the name of the institution and the class start date?
If no, where do you plan on attending an EMT class?
I hereby certify that, to the best of my knowledge, the provided information is true and accurate
Yes
I understand that if I am awarded the $500 scholarship, it will be paid directly to the training institution.
I understand
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Name of the person submitting the application
First Name
Last Name
Name of EMS training institution
Cohort start date
-
Month
-
Day
Year
Date
Proposed class schedule and delivery method (in-person, hybrid, etc.)
Please include the following information for each individual in the cohort
*Click add student to add additional fields for multiple students
Student Information
*
I hereby certify that, to the best of my knowledge, the provided information is true and accurate
Yes
I understand that funds will be paid to the institution upon successful course completion
I understand
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Click below to submit your application
Submit
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