A Registered 501(c)3 Public Charity

Christopher Meadows Paramedic Scholarship Application 2018

Personal Information for Paramedic Application


Full Name

DOB (dd/mm/yyyy)

Address

City

State

Zip

Phone

Your Email


Education

High School Graduate
YesNo

High School Name

High School City

High School State

High School Graduation Date

College Graduate
YesNo

College Name

College City

College State

College Date

From:

To:      

College Degree/Major


EMT Certification

School

Completion Date

License Number

Issuing County

Current County Certificate (Attach)

Recent EMS Work Experience

Current Employer

Address

City

State

Zip Code

Position

Part-TimeFull-Time

Dates of Employment

From:

To:      


Previous Employer

Address

City

State

Zip Code

Position

Part-TimeFull-Time

Dates of Employment

From:

To:      



Community Involvement

List in order of importance to you.

Organization Name

Dates

From:

To:      

Position

Duties (50 Words)


Organization Name

Dates

From:

To:      

Position

Duties (50 Words)



Current Paramedic School(must be currently enrolled)

School

Address

City

State

Zip Code

Course Name and Number

Course Instructor Name

Date of Enrollment (mm/dd/yy)

Anticipated Date of Completion (mm/dd/yy)

Attach proof of enrollment


Reference/Letters of Recommendation

Reference #1

Name

Relationship to you

Attach letter of recommendation

Essay

After reflecting on the background of Christopher Meadows, please write a brief statement in the space below (not to exceed 500 words) that answers the questions “Why do you want to be a paramedic and why do you feel that you should be awarded the Christopher Meadows Memorial Paramedic Scholarship?”


Updload Essay here:


Type your essay or paste it here:

Special Considerations/Hardships (200 words)

Declaration

By inputting your name below you certify that all the information provided in this application is accurate to the best of your ability.

Name

Date