EMT Application

Answer all Questions

APPLICATION INFORMATION

EDUCATION

OFFICIAL TRANSCRIPTS must be mailed to the Office of Enrollment Services (Admissions and Records).  All schools and colleges attended must be listed for the application to be complete.  If necessary, use additional sheets.

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LICENSES AND CERTIFICATIONS

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CONTACT INFORMATION

In case of emergency list two contacts. These contacts should always know where to locate you.

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HEALTHCARE/PUBLIC SAFETY RELATED WORK EXPERIENCE OR VOLUNTEER EXPERIENCE

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PLEASE READ AND SIGN THE FOLLOWING

I hereby certify that the information contained in this application is true and complete to the best of my knowledge.  I understand that any misrepresentation, omission or falsification of information is cause for denial of admission to the program.  I understand that illegal use, possession, and/or misuse of drugs are reasons for immediate dismissal from any programs in the Public Safety Division.  I further understand that background checks and drug screening are routinely required at most clinical facilities prior to the student being allowed clinical placement.