Byrge-Henson-Kaylor Memorial Scholarship Step 1 of 3 33% Tennessee Chapter International Association of Arson Investigators BYRGE-HENSON-KAYLOR MEMORIAL SCHOLARSHIP APPLICATION Dear Applicant: The Byrge‐Henson‐Kaylor Memorial Scholarship is open to any non‐compensated active volunteer firefighter within the State of Tennessee. The purpose of this scholarship is to provide a volunteer firefighter the ability to attend the TN Chapter IAAI’s Annual Training conference. To be eligible for the scholarship the applicant must complete the following application in full and select submit by July 1st. A letter from the applicant’s Fire Chief, Public Safety Director, or equivalent confirming the active firefighter’s status with his department shall be emailed to [email protected]. Contained within this letter there must be a statement of commitment by the applicant to use the training to assist officials involved in the investigation of fires and explosions within the applicant’s jurisdiction All completed applications received by the due date shall be reviewed by the TN Chapter IAAI’s Scholarship Committee. The awardee shall be notified on or about July 15th of the current year of his/her approval. The scholarship shall cover the cost of lodging for the TN Chapter IAAI Annual Training Conference (Sunday through Thursday nights). The cost of the conference registration fee and meals for the week (current GSA per diem rate). Tennessee Chapter International Association of Arson Investigators Name: Address: City: AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State: TN Zip Code: Phone Number:Email Address: Fire Department: Address: City: AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State: TN Zip Code: Chief/Director Name: Address: City: AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State: TN Zip Code: Phone Number:Email Address: Applicant’s Occupation: Employer: Address: City: AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State: TN Zip Code: Phone Number:Immediate Supervisor Name: Tennessee Chapter International Association of Arson Investigators Fire Department Affiliation: (indicate below the one that best describes your department) Full-time, all personnel compensated: Full-time, some personnel compensated: Full-time, no personnel compensated: Part-time, all personnel compensated: Part-time,some personnel compensated: Part-time, no personnel compensated: Applicant’s Education: On a separate sheet(s) of paper list all Fire Prevention, Fire Suppression and/or Fire Investigation training you have received. (copies of certificates are not required). Untitled Applicant’s Experience: On a separate sheet(s) of paper list all the fire departments which you are currently a member and any former fire departments in which you were a member. Affirmation: I certify that I am current and active member of the fire department(s) listed above. I understand that any false statement or information contained in this application shall result in my disqualification for the Byrge-Henson-Kaylor Memorial Scholarship. On a separate sheet pf paper please explain how the training received would benefit you and your department. Untitled Name: PrintDate MM slash DD slash YYYY Signed: Received: Date: Signed: CommentsThis field is for validation purposes and should be left unchanged.
