Kansas EMS Region 4
 1297 16th Road
 Clay Center, Kansas 67432

 

 Phone: (785) 632-6000

Fax: (785) 632-6007 

region4ems@eaglecom.net

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GRANT REQUEST FORM

Region IV EMS has been awarded funding to assist EMS personnel serving EMS agencies within the borders of Region IV with expenses for continuing education. The Region IV Council has established the following policies and guidelines for awarding these funds:
 

  1. Application for the grant funding must be made to the Region IV EMS office prior to the educational event.

  2. If event scheduling occurs after a Region IV meeting date for events before the next scheduled meeting, special e-mail approval may be requested by submitting this form to the Region IV office with detailed explanation of the event scheduling issue.

  3. Applications will be reviewed for approval at regularly scheduled Region IV EMS Council meetings.

  4. Application for funding assistance must be made on this form as approved by the Region IV EMS Council.

  5. Applicant must be affiliated with a licensed ambulance service within the 12 counties of Region IV.

  6. The EMS Administrator of the affiliated service must verify the application by e-mail before the application will be submitted to the board for approval.

  7. This funding will be used for continuing education classes; workshops and applicable expenses only.

  8. A copy of the certificate of attendance or other document showing course completion must be submitted to the Region IV office within 30 days after the scheduled course date or full refund of grant funds will be requested.

  9. Grant recipients who do not complete the educational activity for which they were awarded this grant funding will be required to refund the grant amount, in full, to Region IV EMS within 30 days of the scheduled event.

  10. Extenuating personal circumstances that prohibit course completion will be considered by the Region IV Executive Board upon request of the applicant.

  11. Grant funding will be allowed for registration fees and course materials only following Region IV reimbursement policy. (See policy as stated on the expense reimbursement form.)

  12. Direct bill arrangements with KEMSA and KEMTA can be utilized for payment of registration fees to events sponsored by those organizations instead of reimbursement to the applicant if the service director requests Region IV to make that arrangement.


Please fill out and submit the form using the button below to request an educational grant from Region IV.
 

Questions? Contact the Region IV office at region4ems@eaglecom.net.