Fillable FORM B Scholarship to Adults: Blue Cross Blue (College of the Albemarle)

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FORM B Scholarship to Adults: Blue Cross Blue (College of the Albemarle)

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FORM B Scholarship to Adults
Blue Cross Blue Shield Foundation
Firefighter Scholarship to Adults 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.
Scholarship Award: Up to $1,000 per term (must reapply each term). Funds are disbursed to the student’s
account to cover any expenses for the program/courses to cover instructional costs (tuition, fees, books,
materials, supplies, etc.) associated with an eligible program as listed below. Any balance of funds will be
allocated to the student. Eligible programs: Fire Protection Technology, Public Safety Administration, Emergency
Management or Emergency Medical Science curriculum associate degree programs and Workforce Continuing
Education courses that tie directly to a college’s approved EMS Bridging program and is specifically part of the
student’s pathway to EMS associate degree completion. Eligibility Requirements: 1) Hold an active NC Firefighter
I & II certification; 2) Successfully complete courses covered by the scholarship in any previous term to be eligible
for funding in a subsequent term.
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)/associated degree program student has enrolled in for the term specified:
__ I have provided evidence that I have an active Firefighter I&II certification.
__ If I was awarded this scholarship in the past, I have provided evidence of successfully completing
previous courses.
__ 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 B Scholarship to Adults: Blue Cross Blue (College of the Albemarle)

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Completed 3 February 2021

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