JEFFREY SHAW MEMORIAL SCHOLARSHIP
Sponsored by the
TOWN OF MOUNTAIN CITY BOARD OF MAYOR AND ALDERMAN
The Town of Mountain City’s Emergency Medical Service Scholarship was established for the purpose of
annually providing monetary assistance to an individual interested in pursuing a degree in Emergency
Medical Service and related subjects at a college or university of their choice in memory of Jeffrey Shaw.
Guidelines for the scholarship are outlined in part below:
- Two scholarship awards of up to $500 may be issued annually.
- Applicants must be enrolled or planning to enroll in the next scheduled semester of a two or four year
accredited college or university that offers courses in emergency medical service and related subjects.
These courses must be taken in addition to other required subjects.
- The completed application should be returned to: City Recorder, 210 S Church St. Mountain City, TN
37683 by May 9th. A non-returnable wallet size photograph suitable for publication must be submitted
with the completed application.
- A joint committee comprised of City Hall representatives and the JCHS Guidance Office will blindly
judge scholarship applications.
NAME: __________________________________________________________________DATE_________________
(last)
(first)
(middle)
ADDRESS: _____________________________________________________________________________________
(street no.)
(city/town)
(state)
(zip)
TELEPHONE: _________________________________________DATE OF BIRTH__________________________
(area code)
(no.)
SOCIAL SECURITY NO. _______________________________________
YEAR GRADUATED _______________ GPA _______________ SAT OR ACT SCORE _____________________
COLLEGE OR UNIVERSITY YOU PLAN TO ATTEND _______________________________________________
COURSE OF STUDY ____________________________________________________________________________
REQUIRED ATTACHMENTS:
1. Certified transcripts, senior high school grades and courses studied. If now attending college, certified transcripts
of college work
2. An original essay of 250 words or less entitled, “Why I Am Interested In a Emergency Medical Service (or
related) Career.” The essay must be on a single page 8 ½” x 11”, plain white paper – typed.
3. Recent photo suitable for publication.
CAUTION: The scholarship is intended for the next semester at an accredited 2 or 4 year college or university of your
choice. Failure to do so will require the immediate return of the award.
__________________________________________________________
Signed
________________________________
Dated