Information and Application for the
A. Michael D. Goff Memorial Scholarship
Applicable to the 2026 calendar year
Section 1. Rules for application.
A completed and signed application for the Mike Goff Memorial Scholarship must be
submitted after January 26, 2026 but no later than the close of business on Friday,
February 20, 2026. Applications submitted after the deadline will not be considered.
The completed and signed application is to be submitted to the following email address:
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(Please note: To sign the application, at minimum, the signing feature in Adobe Reader can be
used. A free download of Adobe Reader is obtained by clicking on: https://get.adobe.com/reader/ )
As an option, the completed application may also be mailed via USPS to:
Wayne Cook, 8206 Siding Drive, Church Road, VA 23833
B. C. Section 2. Eligibility.
A. All persons that are members in good standing of a paid or volunteer organization
currently providing fire protection and/or emergency medical services (EMS) to citizens
of the greater Tri-Cities area (the cities of Petersburg, Colonial Heights, Hopewell, and
the counties of Chesterfield, Prince George, and Dinwiddie) and seek education/training,
or higher levels of education/training, in fire protection and/or emergency medical
services.
Section 3. General Information.
A. B. C. D. E. The minimum amount of the scholarship award will be $2,000.00. Solely at the discretion
of the Board of Directors, and if funds are available, multiple scholarships may be
awarded.
The scholarship recipient(s) will be notified by Friday March 6, 2026, with formal
presentation on Thursday, March 19, 2026.
The scholarship is to be used for educational expenses and will be distributed in one of
the following ways:
1. Funds released upon the presentation of receipts.
2. Funds deposited in the students name at the school, college, or university.
3. An alternate manner approved by the Scholarships Board of Directors.
The following factors will be used to determine the selection of the scholarship
recipient(s):
1. The applicants potential to have a positive impact on the safety and welfare of the
public as described in the application Impact statement narrative.
2. 3. Any supporting information furnished with the official application form.
Any additional information that may be requested by the Board of Directors in
support of the application.
The Mike Goff Memorial Scholarship Fund, Board of Directors will select the
scholarship recipient(s) and all decisions will be final.Mike Goff Memorial Scholarship Fund
An IRS 501(c)(3) nonprofit organization
Application for scholarship
Instructions:
1. Please submit a new application each semester or as required by
scholarship criteria.
2. College/Fund may require an attached written statement describing
educational goals and other relevant information.
3. If this application is incomplete, inaccurate, or not signed and dated, it
will not be considered.
Personal Information
Applicant name:
Home address:
City, State and Zip:
Home Phone: Cell Phone:
E-mail:
Who is Mike Goff? Using whatever resources are available to you, please describe who youve learned Mike
Goff to be and what he represented. What do you know about him and why this scholarship was established in his
memory? Provide examples or specific knowledge youve acquired about him on his personal and/or professional
levels. (Character limit: 1,700 including spaces.)General statement of interest or your current involvement in fire and/or EMS. (Character limit: 1200)
Your Academic Information (Complete either Block A or Block B)
A College or University attending:
Have you been officially accepted? Yes
No
Semester for which application is being made
(Term and Year):
Intended major: Semester hours being carried for the semester
referenced above:
Credit Hours earned to date: Current GPA:
B Name of School or training source:
What form of education/training (curriculum/certificate program, etc.) do you intend to pursue?
Will this training lead to a college degree, professional certification, employment
opportunities, or career advancement?
Yes
No
What are (is) the approximate starting and
ending date(s) of education/training?
Where or what is the education/training
location?Briefly list or describe any special awards, honors, or achievements that you have received that may be
relevant to the application. (Character limit: 600)
Impact statement: Briefly state how receipt of the Mike Goff Memorial Scholarship will allow you to
have a positive impact on the safety and welfare of the public. (Character limit: 1100)
Applicant signature: Date of application: