Matt Piles EMS Memorial Scholarship – Online Application

Complete the following application and submit the required documents to apply for the Matt Piles EMS Memorial Scholarship.

Applicant Information

Full Name *

Address *

City *

State *

Phone *

Email *

Education Institution

What EMS program or school do you plan to attend?

School Name *

School Address *

City *

State *

School Phone

Cost of Class/Books/Fees ($) *

Term

In which term will you begin your EMS program? See published deadlines for each term (Fall – July 1, Spring – Dec 1, Summer – April 1).

Fall Spring Summer

Required Documentation

Typed Essay (300+ words, why you want to pursue a career in EMS) *

Letter of Recommendation #1 *

Letter of Recommendation #2 *

Accepted formats: PDF, DOC, DOCX. Max 5MB per file. Recommendations may not be from relatives; if currently employed by an EMS, Fire, or Health Care agency, one letter should be from a supervisor.

Affidavit

By submitting this application for the Matt Piles Memorial Scholarship, I hereby certify that the information herein is true and correct, and I grant Owensville Area Ambulance District permission to verify any and all information provided. If I receive a Matt Piles Memorial Scholarship, I commit to follow the guidelines set forth in this program and to seek certification in the state in which I reside.

Type your full name as your signature *

I agree to the affidavit above and the scholarship program guidelines. *