First Responder Counseling Scholarship Application

First Responder Counseling Scholarship Application Form

For Graduate Students in Counseling or Psychology Degree Programs
I. Personal Data:

Tell us about yourself
Full Name

PrefixFirst NameMiddle NameLast NameSuffix
Birth Date:

MonthDayYear
E-mail :
Where the confirmation will be sent to
Home Address :

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Gender:
Are you a US citizen?
First Responder Experience:

0/500
II. Undergraduate Information:
Did you have complete your bachelor degree during or before May 2025?
Undergraduate School where diploma was received:
Year of Undergraduate Graduation:
III. GPA Information:
GPA composite?
VI. Graduate Degree Seeking Questions:
Please check each of the qualifiers below that apply to you. This data may increase your likelihood of qualifying for the scholarship.
Have you been accepted to a Masters in Counseling or Doctorate in Psychology or Philosophy degree program?
College you plan to attend:
Degree Program you plan to achieve:
Is the University's degree program you are enrolling in a Council for Accreditation of Counseling and Related Educational Programs (CACREP) Accredited Program or American Psychological Association (APA) accredited?
Have you, or will you, receive other scholarships?
If you answered yes, please indicate the amount of scholarship money that you will receive. Check all that apply
Do you qualify for financial aid?
Do you plan to attend the university as a full time or part time student?
Since this scholarship will only cover partial payment of your tuition, how do you plan to pay for the remainder of your tuition?

0/500
What quarter and year do you plan to start your practicum?:
If you are a recipient of this grant, do you agree to complete your academic practicum and internship requirements with Status Code 4, Inc.?
What year do you plan to Graduate?:
VII. Essay
Your essay should be 300-500 words. You should address in your essay: your college goals and choice of major, what you intend to do with your education, and why a scholarship is important to you. Include any academic and non-academic accomplishments, personal characteristics, or experiences that make you uniquely worthy of scholarship consideration.
Essay:

0/500
Please Upload 2 Letters of Recommendation

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VIII. Applicant's E-Signature
E-Signature:
Today's Date:

MonthDayYear
Date
Should be Empty:

First Responder Counseling Scholarship Application Form

I. Personal Data:

II. Undergraduate Information:

III. GPA Information:

VI. Graduate Degree Seeking Questions:

VII. Essay

VIII. Applicant's E-Signature