SPRING 2021 Hampshire College EMS Scholarship Application
Thank you for your interest in HCEMS!
 This form is intended for those wishing to gain a scholarship to attend an EMT class of their choosing, up to the cost of $1,200 in tuition only (supplemental costs not covered). If you have any questions about the application or need assistance, please send us an email at     hampshirecollegeems@gmail.com 
Thank you again for your application and interest in our program!


Please submit by  Sunday the 21rst of February, so we can look at them!!!
Sign in to Google to save your progress. Learn more
Email *
Name, first and last please. *
Legal Name (if different from above)
Pronouns *
Today's Date *
MM
/
DD
/
YYYY
Phone Number *
Please list a phone number that we can contact you at.
Estimated Semester of Graduation *
Area of Study *
Other Certifications *
Wilderness First Responder, Life Guard, etc.
Please explain why you want to be a member of HCEMS (300 words maximum). *
How do you deal with stressful situations? *
How can we help you deal with stressful situations? *
Part of being an EMT on a small campus is that people will identify you and your actions with the program, both on and off call. What does this mean to you and how will you deal with this? *
Please select all of the times that you are available for a 15-minute discussion (the sooner the better). We will review your application and answer any questions you may have. Please check your email after submitting the online form. We will send you an email to confirm the time of your appointment. *
Required
Current or Last Employer *
If no current or last employer write: N/A
Address and Phone Number *
Job Title *
Supervisor's Name *
May we contact your employer? *
Required
Dates Employed *
Duties *
Employer #2 (if relevant)
Address and Phone Number
Job Title
Supervisor's Name
May we contact your employer?
Dates Employed
Duties
Please talk a little bit about how much the scholarship will benefit you and your studies. If the scholarship wasn't available could you still potentially take the class? *
I certify that the above information is true to the best of my ability. *
Please sign your name and enter today's date.
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy