NYSVARA SCHOLARSHIP APPLICATION

Applications must be received by September 10, 2026.

The New York State Volunteer Ambulance & Rescue Association, Inc. Scholarship Program provides recognition of achievement and ability, and assists members (youth and adult) of squads that are members in good standing of NYSVARA, and/or individuals who have been members in good standing of NYSVARA for two (2) or more consecutive years, in continuing their education in an accredited college, university, or paramedic program. Scholarships are awarded based on merit as determined by the Scholarship Committee of the association, whose decisions are final. Applicant must be a high school senior in good academic standing and graduating in June of the year applying, or an adult member furthering their education. Applicant must have applied to and be planning to enroll and pursue a course of study in an accredited college, university, or paramedic program.

Please indicate how you heard about this program (check one or more if applicable)

NYSVARA District
NYSVARA Website
PULSE CHECK Educational Conference
The Blanket – NYSVARA's Newsletter
Other (explain):

A - Applicant

Last Name:*

MI:

First Name:*

Permanent Address:*

City:*

State:*

Zip:*

Home Phone:

Cell Phone:

Email:*

Date of Birth (MM/DD/YY):*

Check One:*
Male Female

NYSVARA Member EMS/Rescue Squad:*

NYSVARA District:*

County:

B - Education

High School Information

Name of High School:*

Phone #:

Graduation Date (mo/yr):*

Address:

City:

State:

Zip:

Colleges You Have Applied To (up to 3)

Name of College 1:

Phone #:

Graduation Date (mo/yr):

City:

State:

Zip:

Check One:
Accepted Waiting

Name of College 2:

Phone #:

Graduation Date (mo/yr):

City:

State:

Zip:

Check One:
Accepted Waiting

Name of College 3:

Phone #:

Graduation Date (mo/yr):

City:

State:

Zip:

Check One:
Accepted Waiting

College You Plan on Attending

Name of College:*

Planned Major:

Planned Minor:

Anticipated Occupation or Career:

Highest Anticipated College Degree:

C - School, Community, and Work Activities

List school activities you have participated in, e.g., publications, debate, music, art, student government, sports, etc. Include any honorary awards, e.g., membership in the National Honor Society.

Activity/Offices Held/Special Awards and/or Honors:

Date(s) of Participation/Award:

Activity/Offices Held/Special Awards and/or Honors:

Date(s) of Participation/Award:

Activity/Offices Held/Special Awards and/or Honors:

Date(s) of Participation/Award:

List additional community activities in which you volunteer or community recognition/awards you may have received.

Name of Agency/Organization:

Position/Description of Work/Award:

Date(s) of Participation:

Hours per Month:

Name of Agency/Organization:

Position/Description of Work/Award:

Date(s) of Participation:

Hours per Month:

Name of Agency/Organization:

Position/Description of Work/Award:

Date(s) of Participation:

Hours per Month:

List jobs (including summer employment) held in the past 3 years.

Employer:

Hours per Week:

Position/Description of Work:

Summer or School Year:

Dates of Employment (From):

Dates of Employment (To):

Employer:

Hours per Week:

Position/Description of Work:

Summer or School Year:

Dates of Employment (From):

Dates of Employment (To):

Employer:

Hours per Week:

Position/Description of Work:

Summer or School Year:

Dates of Employment (From):

Dates of Employment (To):

Additional Activities (optional — use this space if you need to list more than what fits above):

D - NYSVARA Service

Answer the questions below relative to your service with the NYSVARA Member Squad.

Length of Service on NYSVARA Member EMS/Rescue Squad:*

Average Number of Service Hours:

Current Certifications:*
EMT-B CPR First Responder

Additional Certifications or Instructor Certifications:

Explain your activities in support of your EMS agency’s mission (e.g., service on the ambulance, assisting to staff special events, assisting with agency administrative functions, etc.):

Please Explain Why You Are Qualified to Receive a NYSVARA Scholarship and How It Will Help You

Limit your response to no more than 300 words.

0 / 300 words

E - Applicant Certification

I certify that the above information is accurate and complete, and that any financial support received from the New York State Volunteer Ambulance & Rescue Association, Inc. Scholarship Fund will be used in continuing my education in an accredited college, university, or paramedic program. Should I not register or drop out and receive a refund of fees, I understand that I must return any NYSVARA Scholarship funds received. I acknowledge that the above information will be verified by the Scholarship Committee, and any misrepresentation will be grounds for immediate disqualification from consideration for the New York State Volunteer Ambulance & Rescue Association, Inc. Scholarship. I hereby give express permission to the New York State Volunteer Ambulance & Rescue Association, Inc. to share any or all of the information/data I have provided in support of this application with members of the Scholarship Committee and the Board of Directors.

I certify the above statement is true.*

Signature of Applicant (type your full name):*

Date:

F - Recommender Contact Information (if known)

Provide contact information for the person who will be submitting your letter of recommendation (Chief/Captain, President/Vice President, or Youth Squad Advisor). They will certify and submit the actual letter themselves using our Letter of Recommendation form (see Section G).

If you provide an email address below, we will automatically email your recommender a copy of this application along with a link to the Letter of Recommendation form and a reminder of the September 10, 2026 deadline, as soon as you submit. If you leave it blank, please contact your recommender directly to let them know.

Name:

Title:

Phone:

Email:

Agency:

G - Application Materials

All application materials, including recommendations, must be submitted in English. Applications must include:

Completed application form.
A letter of recommendation from your agency Chief/Captain or President/Vice President and for Youth Squad members also one from a Youth Squad Advisor. The goal of the recommendation letter is to learn about you, your goals, abilities, accomplishments, and attributes. Your recommender can submit this letter online using our Letter of Recommendation form.

Applicants are solely responsible for ensuring that the application package — the application form, the recommendation, and any other pertinent data — are submitted (online, or by mail) to:

Scholarship Committee
New York State Volunteer Ambulance & Rescue Association, Inc.
214 Kent Avenue # 278
Endwell, New York 13760

Applications must be received by September 10, 2026; applications postmarked later than the deadline of September 10, 2026 will not be considered. If you have any questions prior to submitting application materials, please e-mail PulseCheck2@nysvara.org.