Fillable Printable Fire Service Application Form - Arkansas

Fire Service Application Form - Arkansas

SOUTHERN ARKANSAS UNIVERSITY TECH

APPLICATION FOR FIRE SERVICE SCHOLARSHIP

Name _______________________________________________________ Social Security Number ___________________________________

Mailing Address _______________________________________________ Fire Department Affiliation _________________________________

City, State, Zip _______________________________________________ Fire Science Management  Fire and Emergency Response 

Home Phone _____________________________________________ Attended SAU Tech previously?  Yes  No

Cell Phone ___________________________________________________ If yes, when? ___________________________________________

E-mail address _____________________________________________ * Initial Application  Renewal Application 

Semester Attending (Choose One):

Fall Spring Summer I Summer II

ELIGIBILITY CONDITIONS

1. Applicant must be employed in fire service in Arkansas or be a volunteer in fire service in Arkansas.

*Submit letter from Fire Department with initial application.

2. Applicant must have successfully completed the Arkansas Fire Academy Firefighter II Certification Program.

*Submit copy of certificate with initial application.

3. Applicant must enroll in one of the fire service degree programs: Fire Science Management or Fire & Emergency Response.

4. Scholarship covers only college credit courses leading to the chosen fire service degree.

5. Applicant must be registered for classes for scholarship to be awarded. If the scholarship application is submitted before the

student is enrolled in courses, the student must contact the Financial Aid office after they enroll.

6. Scholarships will be awarded on a first-come, first-serve basis, provided funds are available.

RETENTION CONDITIONS

1. Scholarship recipients must maintain at least a 2.0 cumulative grade point average.

2. Complete withdrawals for two consecutive semesters of enrollment will result in the loss of the scholarship. To regain

eligibility after such withdrawals, at least one semester must be successfully completed at the student’s expense.

3. Eligibility requirements will be monitored at the end of each semester.

4. Scholarship is renewable until the degree is completed or until the student has attempted ninety (90) credit hours, whichever is earlier.

5. Renewal application must be submitted each semester.

6. Renewal scholarships will be awarded on a first-come, first-serve basis, provided funds are available.

VALUE CONDITIONS

1. Scholarship covers tuition only for college credit courses on the chosen fire service degree plan. It does NOT cover processing fees,

internet fees, non-credit course fees, books, supplies or other costs. Student is responsible for payment of all fees, books, supplies,

and other costs. The scholarship has no refundable cash value.

2. Scholarship does NOT cover specific course fees that are charged in addition to regular per credit hour fees such

as EMT course fees.

I have read and understand the conditions of this scholarship.

Student Signature Date

Return this form along with *copy of certificate and *letter from Fire Department to:

Financial Aid Office

Southern Arkansas University Tech

PO Box 3499

Camden, AR 71 711-1599

Email Kim Nix at knix@sautech.edu

Revised July 2014 Fax 870-574-4422