SC EMS Foundation Scholarship Application

Application Instructions for EMS Scholarship

All applications must be submitted before the class begins or no later than TWO (2) WEEKS 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:*

Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth

MonthDayYear
I am a resident of South Carolina

YesNo
What program are you seeking a scholarship for?
Explain "Other" Here
In your own words, why are you seeking a scholarship from the SC EMS Foundation?
Are you currently enrolled in a class/program?

YesNo
If yes, what is the name of the institution and the class start date?
If no, where do you plan on attending 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 a scholarship, it will be paid directly to the training institution.

I understand

Name of the person submitting the application

First NameLast Name
Name of EMS training institution
Cohort start date

MonthDayYear
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 once 50% of the course has been completed and the student(s) are in good standing.

I understand

Click below to submit your application

If you have any supporting documentation, please email that to mandy.gattis@scemsa.org
Should be Empty:

Application Instructions for EMS Scholarship