SC Emergency Medical Services Foundation Financial Aid Request

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 NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
EMS Agency (if applicable)
Program Type
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
Current EMS Employment (if applicable)
Agency Name and Position/Title
Approximate Annual Household Income Range
Household Size
Other Funding Sources
Have you applied for any other funding sources for this program?
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?
Brief Explanation of Financial Hardship
Please briefly describe why additional financial assistance is needed to complete this program
Are you currently serving in a rural or underserved area?
Do you plan to continue working in EMS after program completion?
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.
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.
I authorize the Foundation to verify enrollment and funding information with the educational institution if needed.
Signature
Should be Empty:

SC Emergency Medical Services Foundation Financial Aid Request

Employment & Income Status

Other Funding Sources

Remaining Financial Need

Attestation and Acknowledgements