Apply for Tuition Assistance

Full Name

Association Name

Provider Level

If other, please specify

County

Address

If not Oregon, what state are you licensed in?

Washington

Idaho

California

Other

If other, please specify

Email

Phone Number

Response to or Serve citizens in a Sovereign Nation

Race

If other, please specify

Area of Response (check all that apply)

Urban

Suburban

Rural Frontier

Paid, Volunteer, or Both

Paid

Volunteer

Both

Maintain National Registry

Yes

No

Please describe why you need tuition assistance

Please describe why you would like to attend this training and the benefit to yourself and your community, using statistics and data when available. How will it benefit your department? Will you be able to share information with other EMS Providers and/or other departments in your area? Do you have support from leadership to attend this training? *

Applicants are required to submit a reference letter from a department leader, city/county official, or other person who can verify your role in the department and how you have contributed to the welfare of the community where you provide emergency care. Must be in a document form or PDF.