SC EMS Foundation Conference Scholarship- Nominee Application
Congratulations, you have been selected to move to the next stage of the conference scholarship application process. Nominees will be asked to submit a personal statement outlining their interest in attending and why they should be selected. Please complete the form below to continue your consideration and upload your personal statement at the end of this form. You will be notified by email once final selections have been made.
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Agency you are employed with
*
Which Conference were you nominated to attend?
*
Please Select
SCEMSA Symposium
SCEMSA Leadership Conference
SC Trauma Symposium
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Next
Will you be attending the Educator's PreCon?
*
Yes
No
Will you need a hotel room?
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Yes
No
What is your requested hotel check-in date?
*
Wednesday, March 25th
Thursday, March 26th
Friday, March 27th
Saturday, March 28th
I don't need a room
What is your requested hotel check out date?
*
Wednesday, March 25th
Thursday, March 26th
Friday, March 27th
Saturday, March 28th
I don't need a room
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Next
If chosen, are you able to cover your own travel, lodging (for SC Trauma Symposium and SCEMSA Leadership Conference only), meals, parking, and any incidental expenses?
*
Yes
No
My agency will be covering this (verification must be provided and submitted below)
You will need a one page personal statement on why you want to attend the conference and why you should be chosen. Please upload your personal statement here:
*
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This is a requirement. If no personal statement is attached, the application will not be considered.
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If additional documentation is needed, please upload that here:
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I acknowledge that, if selected as a scholarship recipient, the scholarship award will be disbursed to my agency of employment rather than to me personally.
*
I understand
If you cannot attend the conference for any reason, you will need to notify Mandy Gattis no later than 10 days before the start of the conference. If you do not, you will be responsible for all registration and lodging fees (if applicable).
*
I understand
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