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: firstname.lastname@example.org
Again...thank you for your interest! - Donna
Which Class Are You Registering For?
Jackson (Holton): January 3rd, 2019
Osage (Osage City): January 3rd, 2019
Date of Birth
Address Line 2
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Saint Kitts and Nevis
Saint Vincent and the Grenadines
Trinidad and Tobago
Bosnia and Herzegovina
United Arab Emirates
Papua New Guinea
Central African Republic
Democratic Republic of the Congo
Republic of the Congo
Sao Tome and Principe
United Republic of Tanzania
Country / Region
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?
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?
Have you ever been certified in EMS before?
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.
Again, thank you for your interest. Please write Donna at email@example.com if you have any questions at any time!