White Bear Rescue

Training Center

P.O. Box 129 Pembine, WI 54156-0129
1-800-776-7199 FAX 715-324-6503
Email:  Training@atlasoutfitters.com

                        Scholarship Application

Name: ______________________________________________________

Address: ___________________________________________________

City: __________________________ State: ______  Zip: ____________

Phone (day): __________________  Phone (Eve): __________________

Email: ______________________________________________________

Training Course: __________________________  Date: _____________

Please Note:

Applicants must be members of a public safety agency, and must be sponsored by that agency,
to participate in the training program.  The agency’s insurance must cover applicants
during participation in the training program.

Applicant’s qualifications to participate in a trainer class are determined by his/her department.

Scholarship funds are limited and are awarded based on financial need of the sponsoring agency.
Scholarships will be awarded only for “Train the Trainer” courses held at White Bear Training Center.

Department: _________________________________________________

Address: ___________________________________________________

City: _________________________ State: ______  Zip: _____________

Phone:  _______________________  FAX: ________________________

Chief or Supervising Officer: ___________________________________
                                            Print name

          _________________________________________
             Signature

Training Information: All items in this section must be completed.

Applicant is:  ____  Career employee of department   ____  Paid on call   ____  Volunteer

Applicant’s years in service:  _________  Rank in department:  __________________

Applicant is a qualified training instructor: ____ Yes     ____  No

 If Yes, which courses does applicant teach?: ___________________________

 _______________________________________________________________

 If No, why is the applicant a good candidate for a “Train the Trainer” course?

 ________________________________________________________________

 ________________________________________________________________

_________________________________________________________________

Applicant has received the following training, paid for by the department, over the past two years. ____________________________________________________________________________

____________________________________________________________________________

Department’s annual training budget: _______________

Please detail training, covered by department’s budget, for this fiscal year.  Include details such as name of course, days or hours involved in course, number of students per course, expense for instructors, miscellaneous expenses involved with training programs.  Use back of sheet for additional information, if necessary,