Christopher Meadows EMT Scholarship

Deadline: November 15, 2025

"*" indicates required fields

Personal Information

Name*

First Last

Date of Birth*

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

Education

High School Graduate?*

Yes

High School Name*

High School Address*

Street Address Address Line 2 City State ZIP Code

High School Graduation Date*

College Graduate?*

Yes

College Name*

College Address*

Street Address Address Line 2 City State ZIP Code

College Date From:*

College Date To:*

College Degree/Major

Recent Work Experience

Employer

Employer Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Position

Employed from:

To:

Employer

Employer Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Position

Employed from:

To:

Community Involvement

Organization Name

Organizations Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Position

From:

To:

Duties

Organization Name

Organizations Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Position

From:

To:

Duties

At which school are you currently enrolled in an EMT program:

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Course Instructor

Proof of Enrollment

Max. file size: 60 MB.

Professional Reference & Letter of Recommendation

Name*

First Last

Relationship to you*

Letter of recommendation (attach file)*

Max. file size: 60 MB.

Essay (up to 250 words) answering the question “Why are you taking this EMT course and why do you feel you should you be awarded the Christopher Meadows Memorial EMT Scholarship?” and reflecting on the background about Christopher Meadows found in the application guidelines.

Or Attach File Below

Attach essay file

Max. file size: 60 MB.

Special considerations or hardships you would like the interview committee to consider.

Declaration: I certify that the information in this application is correct and accurate to the best of my ability.*

Certify

Signature*

Date*

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