EMS Scholarship Request Form
Completion of this form does not guarantee a scholarship. EMSE scholarships may provide up to $2000 for the EMT program and $8000 for the paramedic program.
Name
*
First Name
Last Name
Panola College Student ID #
*
If you have not applied to Panola College yet, please type "Not Applied"
Email
*
Confirmation Email
Please use an email you check regularly
Phone Number
*
Please enter a phone number where we can reach you
Are you at least 18 years old?
*
Yes
No
Are you a US Citizen?
*
Yes
No
Have you ever been convicted of a felony, DWI, or domestic violence charge?
*
Yes
No
I understand that if I receive a EMSE scholarship, I must successfully complete the class and the NREMT certification examination. In addition, I must provide one (1) year of service as an EMS provider in an ambulance at the EMT level or two (2) years as an AEMT or Paramedic within the State of Texas.
*
I understand
Submit
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