Rise Memphis

Complete the RISE Interest Form below. A RISE Advocate will contact you to help create the best route for you.

Full Name*

Please include your first and last name

Phone Number*

Please include your area code

Email Address*

Employer*

Please enter the full name of your employer

Current Certifications

Paramedic

EMT

Firefighter

Other

Please check all current certifications

Program of Interest*

Education Level*

Are you currently enrolled in college?*

Have you ever attended the University of Memphis?*

How did you hear about RISE?

Email

Poster or Flyer

Coworker or Training Center or Friend

Other

I authorize my employer to release my training record to the University of Memphis*

To receive tuition assistance through this program we must share your educational records (including financial aid, grades, academic progress, etc) with your employer. The privacy of your educational records is normally protected under the Federal Educational Rights and Privacy Act (FERPA). Please review the FERPA guidelines linked below and respond to the following statement: I approve the release of my educational information to my employer and any third party directly related to my tuition benefits. I understand that this information is normally protected under FERPA guidelines, however I give my consent to share this information for the purpose of this program’s direct billing process. I also understand that if I do not give my consent, I will not be able to participate in this program.

Tuition Assistance Authorization

Yes

No

Ready to RISE to success?