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EMT Initial Course Application
Thank you for your interest!
The initial EMT course is an intensive, time consuming course.
An additional requirement of field internship participation will be required. There are no make-up classes and students must attend at least 90% of class time. Additional dates & times may be added throughout the course if and as needed. Additional, non-mandatory days will be available after class to practice for practical exams.
This class is open and available to anyone. However, you must be at least 17 years of age to challenge the State and National test.
Application Deadline: 15 days prior to the first day of classes. Classes will be cancelled if there are not at least 10 participants.
PLEASE NOTE: Any incomplete application that is received will be considered invalid. Applications for the EMT Course frequently exceed the number of spaces available. These are placed on a waiting list.
The cost of this class is $1,850 to include tuition, books, and lab fees. This fee MUST BE PAID BY THE FIRST DAY OF CLASS. If you are with a service or department, there is an additional form for them to sign and fee may be available at a discounted rate.
Questions regarding the application process should be directed to Donna Connell at TECHs, Inc. Education (preferred method of communication) by email: medic_721@hotmail.com
Again...thank you for your interest! - Donna
Which Class Are You Registering For?
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Jackson (Holton): January 3rd, 2019
Osage (Osage City): January 3rd, 2019
Name
First
Last
Date of Birth
Address
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Aruba
Bahamas
Barbados
Belize
Canada
Cayman Islands
Cook Islands
Costa Rica
Cuba
Dominica
Dominican Republic
El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Mexico
Netherlands Antilles
Nicaragua
Panama
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
United States
Argentina
Bolivia
Brazil
Chile
Colombia
Ecuador
Guyana
Paraguay
Peru
Suriname
Uruguay
Venezuela
Albania
Andorra
Armenia
Austria
Azerbaijan
Belarus
Belgium
Bosnia and Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Italy
Kosovo
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Moldova
Monaco
Montenegro
Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Ukraine
United Kingdom
Vatican City
Afghanistan
Bahrain
Bangladesh
Bhutan
Brunei Darussalam
Myanmar
Cambodia
China
East Timor
Hong Kong
India
Indonesia
Iran
Iraq
Israel
Japan
Jordan
Kazakhstan
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Lebanon
Malaysia
Maldives
Mongolia
Nepal
Oman
Pakistan
Palestine
Philippines
Qatar
Russia
Saudi Arabia
Singapore
Sri Lanka
Syria
Taiwan
Tajikistan
Thailand
Turkey
Turkmenistan
United Arab Emirates
Uzbekistan
Vietnam
Yemen
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
Nauru
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Democratic Republic of the Congo
Republic of the Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Gibraltar
Guinea
Guinea-Bissau
Cote d'Ivoire
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
United Republic of Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
Country / Region
Email
Phone
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Phone
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Current Driver's License Number
Issuing State of Driver's License
High School Attended & Year Graduated
College Attended & Degree, If any.
Have you ever been convicted of a felony?
Yes
No
Currently Pending A Court Decision
List any experience, education, certifications, or other information about yourself that you find applicable.
(This can include any field training in your current profession, promotions, interesting talents, certifications, such as, CPR, etc.)
Are you physically able to do the work of an EMT, including heavy lifting, working in rough terrain, and working in hot/cold temperatures?
Yes
No
Have you ever been certified in EMS before?
Yes
No
If yes, where and what was your certification?
Name of fire department or EMS service you are affiliated with, if applicable:
Email address for your supervisor, if applicable.
Applications will be reviewed and applicants will be notified.
You must be 18 years of age to challenge the state/national exams for certification - at least 17 years of age to attend the class.
Checking this box indicates that you have read, understand, and meet all of the requirements that are mandatory for your enrollment in the BLS training course.
I have read the information provided and understand the selection process.
Why would you like to take this class?
Upload resume or any other documents you wish. These will be attached to your application and sent to the selection committee.
Thank you!
Again, thank you for your interest. Please write Donna at medic_721@hotmail.com if you have any questions at any time!