Fillable FORM A Stipend: Blue Cross Blue Shield Foundation (College of the Albemarle)

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FORM A Stipend: Blue Cross Blue Shield Foundation (College of the Albemarle)

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FORM A Stipend
Blue Cross Blue Shield Foundation
Firefighter Stipend Application
Please confirm if your college is an eligible college and if it is offering this option for the term you are interested in.
Return the completed application form to the college Financial Aid Office by the deadline specified by the college.
The stipend is for $500 per term and students must reapply for each subsequent term. Funds are disbursed to the
student’s college account to cover any expenses for the program/courses to cover instructional costs (books,
materials, etc.) associated the designated fire fighter training within a NC community college. Any balance of funds
will be allocated to the student.
The student must enroll in course(s) required to achieve the NC Firefighter I & II, NC Driver/Operator Pumps,
and/or Emergency Vehicle Driver certifications to be eligible for these funds.
College
Name
Student Information (please print)
Full Name
Home Address
City/State/Zip Code
Email Address
Phone Number
Mobile Number
Specify Term Applying For: ___________________ (Example: Fall 2020, Spring 2021, Summer 2021)
List eligible course(s) student has enrolled in for the term specified above:
I have read and understand the requirements for this funding. I hereby declare that the information
provided on this form is complete and correct to the best of my knowledge.
Applicant Signature: _______________________________________ Date: ____________
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FORM A Stipend: Blue Cross Blue Shield Foundation (College of the Albemarle)

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Completed 3 February 2021

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