SC Emergency Medical Services Foundation Financial Aid Request
Please fill out the information below as part of the SC Emergency Medical Services Foundation application process. Please be aware that EMT-B is currently not being funded by the SC EMS Foundation. If you would like to find EMT-B Funding options, please contact Dr. Mandy Gattis at mandy.gattis@scemsa.org.
Full Legal Name
*
First Name
Last Name
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
EMS Agency (if applicable)
*
Program Type
*
Please Select
A-EMT
Paramedic
Leadership
Other(please explain)
If "other" please list here
Name of Educational Institution
*
Program Start Date
*
Program End Date
*
Total Cost of the Program (tuition and any related fees)
*
Please upload a personal statement outlining your reason for applying for Foundation funding and describing how this support will help you.
*
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Employment & Income Status
Current Employment Status
*
Please Select
Full-time
Part-time
PRN
Unemployed
Student Only
Current EMS Employment (if applicable)
*
Agency Name and Position/Title
Approximate Annual Household Income Range
*
Under $25,000
$25,000-$49,999
$50,000-$74,999
$75,000+
Household Size
*
Other Funding Sources
Have you applied for any other funding sources for this program?
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Yes
No
If yes, please list those sources, if you were approved or denied, and the amount you were approved for (if approved). These could include: Federal financial aid (FAFSA), State workforce or technical education funding, Employer/agency sponsorship, Local or national scholarships, GI Bill / military education benefits, Payment plan with the school, Other (please list)
*
For each funding source listed, please advise of the status as: Approved (full), Approved(partial), Denied, Pending, Eligible but chose not to apply (note: this may be disqualifying)
If denied, upload or attest to denial here
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Remaining Financial Need
Total Program Cost
*
Total Funding Awarded from Other Sources
*
Remaining Out-of-Pocket Balance
*
Are You Able to Pay the Remaining Balance Without Hardship?
*
Yes
No
Partially
Brief Explanation of Financial Hardship
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Please briefly describe why additional financial assistance is needed to complete this program
Are you currently serving in a rural or underserved area?
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Yes
No
Unsure
Do you plan to continue working in EMS after program completion?
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Yes
No
How will completing this program impact your career or agency?
*
Attestation and Acknowledgements
I certify that the information provided is accurate and complete to the best of my knowledge.
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I Understand
I understand that the Foundation serves as a funder of last resort and that failure to apply for or disclose other funding sources may result in denial.
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I Understand
I authorize the Foundation to verify enrollment and funding information with the educational institution if needed.
*
I Understand
Signature
*
Submit
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