A Registered 501(c)3 Public Charity

Christopher Meadows Paramedic Scholarship Application

    Personal Information

    Your 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


    Recent 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)


    At which school are you currently enrolled in an EMT course? (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/Letter of Recommendation

    Reference

    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 250 words) that answers the questions “Why do you want to be an EMT, and why do you feel you should you be awarded the Christopher Meadows EMT 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

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