AMERICAN RESCUE PROGRAM SCHOLARSHIP APPLICATION

First Name *

Last Name *

Phone Number *

Email Address *

Physical Mailing Address *

City *

State *

Zip Code

Highest Level of Education Completed *

Please Upload A Copy Of Your High School Diploma, GED, Or Transcripts. *

Choose File

Are You The Sole Income Earner In Your Household? *

Yes

Total Number of Household Members *

Total Household Income *

Please Upload Proof of Household Income (ex. pay stubs, tax returns, etc.)

Choose File

Do You Reside In The City of Las Vegas? *

If you do not know if you live in the City of Las Vegas, please go to https://maps.clarkcountynv.gov/gismo/apps/jurisdiction/app/index.html. Type in your address and click VALIDATE. If the Jurisdiction says Las Vegas you live in the City of Las Vegas. If the Jurisdiction says anything other than Las Vegas (ie. North Las Vegas, Clark County, Boulder City, Henderson, etc.) then you do not live in the City of Las Vegas.

Please Provide Proof Of Residency (Utility bill within last 3 months, current lease agreement, current mortgage statement, residential deed or title, a letter on letterhead from a shelter or non profit entity attesting that the applicant resides at the provided address) *

Choose File

If You Would Voluntarily Provide Your Race, please enter it here.

Are You Currently Employed? *

Are You Full Time Or Part Time? *

What Is Your Current Hourly Wage? *

How Long Have You Been Unemployed (In Months)? *

What Industry Or Positions Have You Worked In Previously?

What Was The Reason For Your Loss Of Last Previous Employment? Please Be As Specific As Possible. *

What Industry Or Positions Have You Worked In Previously? *

If After Successful Course Completion And Obtaining National Licensing You Are Offered Full Time Or Part Time Employment Would You Accept It?

If You Were To Accept An Offer Of Full Time Or Part Time Employment, What Would Be An Estimated Time Frame Before You Would Be Able To Begin Work? *

Is Your Goal In Taking This EMT Course To Find Full Time Employment In The Medical, EMS, Or Public Sector Industries? *

What Experience Do You Have Serving Your Community? This Might Be Formal Experience Such As Volunteering At A Non Profit, Or Informal Experience Such As Helping Out Neighbors, Or Assisting At A School Or Church. *

What Interests You About Becoming An EMT? *

What Are Your Future Employment Goals? Do You Hope To Work For An Ambulance Company, A Fire Department, Police Department, Etc.? *

How Would You Rate Your Ability To Interact With People Of All Types And From All Backgrounds? *

How Would You Rate Your Ability To Manage Stressful Environments Or Situations? *

Would You Describe Yourself As Someone Who Can Maintain Calm During Emergency Or Stressful Situations? *

How Would You Rate Your Ability To Witness Or Partake In Circumstances Where Body Fluids Or Blood Or Physical Trauma Might Be Evident And May Require Physical Interaction? *

If We Are Considering You And Another Applicant For The Final Scholarship Spot, Why Should We Chose You? *

What Do You Feel Are Some Of The Personal Challenges You Have Experienced That Have Led To Your Struggle With Finding Or Maintaining Gainful Employment? *

If Not Approved For Scholarship, Would You Be Able To Attend One Of Our EMT Programs At Their Current Price Utilizing Full Payment Or One Of Our Payment Plans? *

If You Would Not Be Able To Pay For Your EMT Program Without Use Of These Scholarship Funds, Please Describe Why Not Or What Financial Barriers You Are Currently Facing. *

Do You Agree To Participate In Quarterly Surveys For The Next 15 Months? These Will Be Sent To Your Email, Take Approximately Five Minutes Each, And Will Ask Questions Regarding Your Testing And Licensing Completion Process, Future Employment, Wages, etc.? This Will Be A Mandatory Part Of Our Scholarship Program. *

Is There Anything Else We Should Know About You Or Your Future Personal And Career Goals? *

Feel Free To Utilize The File Upload To Add Any Additional Documents, Images, Videos, That You Would Like Us To Review And Consider Along With Your Application. *

Choose File

Disclaimer: Supplmental documentation relating to address verification and household income will need to be submitted and verified.

Your application has been sent for consideration.

There was an error trying to send your message. Please try again later.

AMERICAN RESCUE PROGRAM SCHOLARSHIP APPLICATION

Title