MAVEN EMS Academy, LLC
EMT- Basic TUITION SCHOLARSHIP APPLICATION
Return to: MAVEN EMS Academy, LLC
2966 KY 206
Dunnville, KY 42528
(606) 787-8211
A. Complete all requirements of the Tuition Scholarship Application
B. Please type or legibly print an essay of approximately 250 words on your desired role in and perspective of Emergency
Medical Services and reasons why this scholarship should be awarded to you.
C. Attach a copy of your high school diploma, GED or high school transcript. (Must be at least 16 years of age, enrolled
in High School with at least a 2.0 GPA or higher)
D. A minimum of two and no more than three personal recommendations must be submitted with the application as outlined
on the instruction sheet.
E. Outline any school / community / work experience and awards / honors / special recognitions you have received. (use
a separate sheet to answer.)
F. If selected as a potential recipient, the applicant must meet all course application requirements and pass a criminal
background check.
SS# _______________ (For Criminal Background Check)
Name _________________________________________________________
First
Middle
Last Maiden
Sex* ______ Age _____ (must be at least 18 years old to apply unless 16 years old HS student with 2.0 GPA)
Home Address ________________________________________________________
Street/Box Number City State Zip
County ___________________ Home phone number ( ) _________________
Applicant gross family income __________ Number of household members ________
Note: Only the information marked with an (*) is optional, all other areas must be completed in full.
I HEREBY ATTEST to the accuracy of the information I have included in this application and give my permission for the use
of my information in media releases or internal audits. I understand my full application is to be reviewed by MAVEN EMS Academy,
LLC for selection. I understand that MAVEN EMS Academy, LLC retains the right to adjust my individual scholarship awards to
effectively utilize MAVEN EMS Academy, LLC dollars.
SIGNATURE________________________________________ DATE ____/____/____
Tuition Scholarship Criteria
An award for tuition cost only, in an amount not to exceed Five Hundred Dollars ($500.00) will be
made on behalf of qualified individuals selected as scholarship recipients. Deadline for application is set at seven days
prior to the first day of class and is considered only for the next course scheduled. A minimum enrollment of ten
students is required for Tuition Scholarship to be offered.
Purpose: To promote quality EMS education and recognition of MAVEN EMS Academy, LLC in the EMS community.
CRITERIA
Applicant must have and attach a copy of their high school diploma or GED. (or be at least 16 years old enrolled in high
school with at least a 2.0 GPA. Attached copy of high school transcript is required)
Applicant must have a current driver’s license.
Applicant must show intent to apply to an EMT course being offered by MAVEN EMS Academy, LLC.
Applicant must submit a completed scholarship application and complete ALL requirements of the scholarship application.
Applicant must complete an EMT course application and meet all application requirements.
Applicant must submit a single page, typewritten essay explaining why he/she desires to further his/her education in EMS
Applicant must submit at least two (2) letters of recommendation from an EMT First-Responder or Basic Instructor, EMS Director,
Fire Chief or other EMS personnel.
Applications must be submitted no later than seven days prior to the first day of class that you have applied to attend.
Applications will be screened and a candidate selected by the MAVEN EMS Academy, LLC scholarship review professional.
Tuition Scholarship award checks shall be made payable to MAVEN EMS Academy, LLC EMT program in the name of the scholarship
winner.
In the event that the selected candidate does not complete the designated program, the scholarship recipient will be required
to reimburse all scholarship monies to MAVEN EMS Academy, LLC. within 30 days of their last date of attendance
unless
absence is due to military related duties.
Mail completed applications to:
MAVEN EMS Academy, LLC.
2966 KY 206
Dunnville, KY 42528
Attn: Rhonda J Patton-Garrett
