Back the Badge Scholarship Application | Hendricks College Network

Name*

First M.I Last

Address*

Street Address Address Line 2 City State ZIP Code

County*

Phone*

Email*

DOB*

Ethnicity

Hispanic or Latino
Not Hispanic or Latino

Race

American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander
Asian
White
Black or African American
Other

If other, please specify.

Are you currently certified in Indiana as an EMT?*

Yes
No

Are you currently employed as an EMT?*

Yes
No

When do you plan to enroll in a paramedic program?*

What training program/school are you attending or plan to attend?*

Have you been accepted into a Paramedic Program?*

Yes
No

How much will the program cost or what are your remaining costs? (if unknown, please state "unknown")*

Where is your intended program located?*

Do you have a high school diploma and/or equivalent?*

Yes
No

How would this scholarship benefit you in completing a Paramedic Science program and why are you interested in this profession? (Please briefly answer each question with a minimum of 100 characters and maximum of 500 characters)*

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