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