Contact information
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
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Financial Need Assessment
Occupation
*
Please indicate if you have an occupation other than student.
Employment status
*
Please Select
Full-time
Part-time
PRN (as-needed)
Estimated household income
*
Number of dependents
*
Marital status
*
Applying for
*
Please Select
Tuition assistance
Student need
Please consider me for both
NOTE: Eligible candidates who are awarded will receive one award in the amount allocated per the Scholarship Committee and based on demonstration of need, number of eligible applicants, and funding availability.
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Education
High school name or GED
*
Graduation year
*
College name
Graduation (or anticipated graduation) year
Program name
*
Program address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Program lead instructor name
First Name
Last Name
Program lead instructor phone number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Program lead instructor email
*
example@example.com
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References
May we contact your references?
*
Yes
No
First Reference
Name
*
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Second Reference
Name
*
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Third Reference
Name
*
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
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Interview Questions
Why are you interested in becoming a paramedic?
*
When you complete your training, where do you plan to work as a paramedic?
*
In what ways have you provided service to your country and community?
*
Why do you believe you should be considered for a scholarship from MARCER?
*
If applying for a student need scholarship, please describe how the funds would assist your program completion.
*
Application documents
Please note that all applications must include a resume, copy of your EMT license, two letters of recommendation and proof of enrollment and good standing in an eligible paramedic training program.
Resume
*
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Copy of current EMT license
*
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First letter of recommendation
*
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Second letter of recommendation
*
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Proof of enrollment and good standing in an eligible paramedic training program
*
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Attestations
Have you ever been convicted of a felony or misdemeanor?
*
Yes
No
Have you ever been convicted of driving under the influence?
*
Yes
No
Have your driving privileges ever been revoked?
*
Yes
No
Have you ever been disciplined or discharged for theft or dishonesty?
*
Yes
No
Any additional comments?
To the best of my ability, I attest the above information to be accurate and true.
*
Yes
No
Signature
*
Submit
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