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C s F p a o c S (Lord Fairfax Community College)

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U.S.A. forms for Lord Fairfax Community College

BROWSE LORD FAIRFAX COMMUNITY COLLEGE FORMS

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To honor and support children that
have lost a parent in an air medical or
critical care transport accident.
2
MedEvac Foundation International
Children’s Scholarship Fund
The MedEvac Foundation International is an international nonprofit 501(c)(3) charitable organization
headquartered in the Washington, DC area. The Foundation helps the Association of Air Medical
Services (AAMS) represent the Air Medical and the Critical Care Ground Transport Industry. Since
2005, the MedEvac Foundation International has supported research, education, and outreach programs
that enhance the industry’s ability to provide quality medical care and provide safe and effective air
and ground medical transportation for every patient in need. We fund programs and charitable
activities that support AAMS’ members and their families, who serve their communities with pride and
commitment and provide life-saving services throughout the United States and around the world.
The Children’s Scholarship Fund was developed to provide financial assistance for higher education to
children who lost a parent in an air medical or critical care ground transport accident. We will fund
two scholarships (one for air medical and one for critical care transport) in the amount of $5,000 each
to a deserving student entering or enrolled in a college, university, or vocational-technical school.
Eligibility
Applicants must:
o Be enrolled or accepted into an accredited college, university or vocational-technical school.
o Be a legal U.S. resident.
o Submit a complete application and all required documentation.
o Be a dependent and/or an immediate relative of a medical transport crewmember that lost their
life due to an air medical or critical care transport accident. This includes parents, step-parents,
legal guardians, and grandparents.
Application Instructions
o Type (preferred) or print and complete all requested information in full.
o Prepare a 300-word essay on one of the following topics:
1. Evaluate a significant experience, achievement, risk you have taken, or ethical dilemma you
have faced and its impact on you.
2. Describe your leadership achievements or significant service contributions to your school
or community.
3. Describe a significant event or person in your life that has influenced your future plans. Tell
us what your plans are and how the significant event or person helped create those plans.
o Have a teacher / professor, or guidance counselor complete the Educator’s Statement.
Statements must be submitted in a sealed envelope from the author.
o Submit one letter of recommendation from someone other than an educator or family member
(a mentor, manager at your employment or volunteer position, community leader, etc.).
Recommendations must be submitted in a sealed envelope from the author.
o Include your most recent grade transcript.
o All signatures must be provided where indicated on the application.
3
Terms and Conditions
o Two $5,000 scholarships will be awarded yearly.
o Applications will be evaluated on all of the information provided in this application.
o All applications will be reviewed and chosen by a qualified selection committee.
o Scholarships will be awarded on a one-time basis and will not be renewable.
o The award will be paid directly to an institute of higher education upon proof of enrollment.
o Scholarships will be awarded without regard to race, ethnicity, national origin, religion, gender,
or disability.
o Incomplete applications will not be considered. Please refer to the checklist below to ensure
that all components of the application have been fulfilled.
For more information, please visit www.medevacfoundation.org
or contact Krista Fuentes at kfuentes@aams.org or 703-836-8732.
Application Checklist
□ Completed application form
□ Transcript
□ 300-word essay
□ Educator’s statement (sealed)
□ Letter of recommendation (sealed)
MedEvac Foundation International
Attention: Krista Fuentes
Children’s Scholarship Fund
909 N. Washington Street, Suite 410
Alexandria, VA 22314
4
THIS PAGE IS TO BE COMPLETED BY ONE OF YOUR TEACHERS / PROFESSORS OR
YOUR SCHOOOL GUIDANCE COUNSELOR.
To be submitted by Student with Completed Application in Sealed Envelope.
**Teacher/Counselor: Please fill out and place form in a sealed envelope before returning to student.
Applicant’s Name: Date:
School Name:
Evaluator’s Name: Position:
Please describe whatever you think is important about this student, including a description of academic and personal
characteristics. We are particularly interested in a candidate’s intellectual promise, motivation, relative maturity, commitments
to service, integrity, special talents, enthusiasm, overcoming hardships and initiative. We welcome any information that will
help distinguish this student from others. Please submit your comments below – attach additional page if necessary.
Personality & Character Evaluation
Compared with other high school seniors, how would you rate this student in the following areas?
Poor
Average
Positive
Attitude
Enthusiasm &
Support of School
Respect for
Others
Leadership
Qualities
Academic
Achievement
Sense of
Responsibility
High Principles
and Values
Signature of Evaluator
EDUCATOR’S STATEMENT
5
COLLEGE SCHOLARSHIP APPLICATION
Instructions:
1. Please fill out the College Scholarship Application.
2. Please type (preferred) or print and complete all information, no pencil.
3. Include all requested attachments and submit via U.S. Postal mail.
Name Social Security Number
First Middle Last
Address
City State Zip
Telephone ( ) Email
Name of Relative That Lost Their Life in the Medical Transport Accident
Total Current Family Income
# of Dependent Children in the Family # of Children Currently Enrolled in College
High School You Currently Attend (if applicable)
Grade Point Average (please provide your un-weighted GPA cumulative)
SAT Score (Combined) ACT Score (Combined) Only one is necessary: SAT or ACT
College or University You Attend or Plan to Attend
College or University Telephone (Admissions Office) ( )
Have You Been Accepted? If No, When Will You Hear?
Anticipated Major: Anticipated Career:
List Other Scholarships, Grants or Loans You Have Applied For and Amounts of Each (attach additional pages if necessary):
Work Experience: List your work experience over the last four years, in chronological order, with your most recent job
listed first. Attach additional page if necessary.
Company
Position/Job Description
Employed
From
Employed
To
Average Hours
per week
6
COLLEGE SCHOLARSHIP APPLICATION
School Activities: List all school activities in which you have participated in the last four years (i.e. Athletics, Student
Government, Clubs). Attach additional page if necessary.
Activity
Timeframe
Position (i.e.
captain, treasurer)
Average
Hours / Week
Comments
(i.e. Special Awards)
Community and Volunteer Activities: List all non-paid community activities in which you have participated in the last
four years (i.e. volunteer efforts, church work). Attach additional page if necessary.
Activity (i.e. Soup Kitchen)
Timeframe
Position
Average
Hours per
Week
Comments
Awards and Honors: List all awards and honors received in the last four years (including academic awards or honors).
Attach additional pages if necessary.
Year
Award or Honor
(i.e. Eagle Scout Badge, National Merit Scholar)
Comments
(Describe the Honor - Why Given)
Special Circumstances: Relay any additional information you feel the Selection Committee should consider in the
selection process. Please provide this information in an attachment to this application – please type your response. Do
not answer this question if you feel that there is no “special circumstances” or important facts to relay.
Submit essay as attachment: Essay should be approximately 300 words, typed, 12-point Times New Roman font, single-
spaced with one-inch margins. Please address one
of the following statements or questions:
1. Evaluate a significant experience, achievement, risk you have taken, or ethical dilemma you have faced and its
impact on you.
2. Describe your leadership achievements or significant service contributions to your school or community.
3. Describe a significant event or person in your life that has influenced your future plans. Tell us what your plans
are and how the significant event or person helped create those plans.
Applicant Certification
I hereby certify that all of the information provided in this application is complete and true to the best of my knowledge. I
herby grant permission to the MedEvac Foundation International to contact my references and/or school if necessary, and
to use my name and likeness in promotional materials in the event that I am selected to receive a scholarship award.
Signature of Applicant Date
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C s F p a o c S (Lord Fairfax Community College)

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Completed 8 October 2020

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