ROCKERVILLE VOLUNTEER FIRE DEPARTMENT

S.A.F.E.R. GRANT PROGRAM

SCHOLARSHIP PACKET

2014 PROGRAM YEAR

MAIL COMPLETED APPLICATION AND REQUIRED ATTACHMENTS TO:

ROCKERVILLE VFD

13720 S. HIGHWAY 16

RAPID CITY, SD 57702

ROCKERVILLE VOL. FIRE DEPT.

SCHOLARSHIP APPLICATION

-----ELIGIBILITY REQUIREMENTS-----

  1. WITHIN 30 DAYS OF SCHOLARSHIP AWARD, must successfully pass a pre-employment drug screening and an NFPA Standard 1582 compliant medical physical examination.
  2. Upon scholarship award, must successfully pass a driving record screening.
  3. Must agree to attend a minimum of 67% of Rockerville VFD meetings. This includes regularly scheduled department business meetings, training sessions, and work details.
  4. Within 60 days of scholarship award, must successfully complete the online classroom portion of NWCG S130, S190, ICS100, 200, 700, & 800.
  5. Must participate in Department scheduled/sponsored basic wildland field training day.
  6. Scholarship recipients that already have any of these training certifications may satisfy the requirement by providing copies of their official class completion certificate (certificate must meet RKVFD specifications).
  7. Course load must be equivalent of a “full-time” student. Scholarship recipient is responsible for arranging for the school Registrar to provide proof of enrollment and course load prior to funds being provided to the school.

Candidates that are awarded scholarships must meet these requirements prior to any funds being transferred. Failure to meet these requirements will result in cancellation of the scholarship award. The Rockerville VFD will directly pay the costs of the drug screening, driver’s license review, and physical examination.

Application Deadline: Postmarked no later than November 30, 2013.

Award Period: Spring and Fall Term 2014

Scholarship Amount: $2,500 – scholarships are awardedas $1,250 for each semester (will be paid directly to your school)

first name / middle initial / last name
mailing address / social security number
city, state, zip code / program of study
phone number / name and location of intended school
anticipated graduation date / cumulative GPA (4.0 scale)
Are you receiving other financial aid assistance? / YES / NO
If yes, list sources of assistance and amounts:
name / amount
name / amount
name / amount
name / amount
What is your anticipated career field after graduation?
Have you been an active member of the Rockerville VFD for a minimum of two (2) years? (NOT a requirement for scholarship award) / YES / NO
Are you a dependent of a Rockerville VFD member that has been active for a minimum of two (2) years? (NOT a requirement for scholarship award) / YES / NO
Have you been a member or a dependent of a member of another Emergency Services Agency for a minimum of two (2) years? (NOT a requirement for scholarship award) / YES / NO
If YES, please state name and location of agency

Applicants MUST also attach to this application:

  1. Grade transcripts from past studies including high school and any completed higher education.
  2. Narrative essay which states why the applicant feels they should be awarded this scholarship, how their participation might impact the volunteer fire service and themselves, past community involvement, career goals, etc. Applicants should be aware this essay will be a large portion of the evaluation process.
  3. A minimum of TWO letters of recommendation from parties that are not family relatives of the applicant. At least one letter of recommendation MUST be from a former instructor/teacher. Additional letters of recommendation are allowable and encouraged.
  4. A completed statement of agreement (see attachment to this application) indicating the applicant’s agreement to become fully involved in the activities of the Rockerville VFD as a firefighter/first responder for no less than the term of the scholarship award. Failure to provide this agreement will be cause for the application to not be considered for evaluation.

By signing below, I certify that the information submitted in this application is true and correct to the best of my knowledge. I also authorize the Rockerville VFD Selection Committee to access my academic and financial assistance records to authenticate the information needed to select the recipients of this scholarship. Further, I agree to provide a suitable photograph upon scholarship award for the purposes of announcing and promoting this scholarship; and I authorize the use of said photo along with my name for said purpose.

Signature ______Date ______

ROCKERVILLE VOLUNTEER FIRE DEPARTMENT

S.A.F.E.R. GRANT SCHOLARSHIP PROGRAM

DEPARTMENTAL PARTICIPATION AGREEMENT

By signing below, in exchange for receipt of scholarship funding, I agree to become a fully functional member of the Rockerville VFD, and to fully participate to the best of my abilities in all the activities of the Rockerville VFD. Such activities will include, but are not limited to: Responses to All-Hazard Emergency Situations (fires, emergency medical, motor vehicle accidents, etc.), Department sponsored training drills, Departmental business meetings, routinely scheduled work sessions, etc.

I also acknowledge that I am subject to all Departmental Standard Operating Guidelines, policies, and procedures. I also understand that in no manner shall this agreement or payment of scholarship funds be considered a contract for employment.

Failure to participate as stipulated in the scholarship application may result in forfeiture of scholarship award. Participation in the first semester will determine if the scholarship will be paid in the second semester.

Name______

Signature______

Date______