Gulf Coast State College | EMT Application

Answer all Questions

What term are you applying for?FallSpringSummer

APPLICATION INFORMATION

Last Name: (Required)

First Name: (Required)

Street Address: (Required)

Zip Code: (Required)

Student ID: (Required)

Student Email Address: (Required)

Secondary Email Address: (Required)

Home Phone: (Required)

Have you previously applied to the program? (Required)YesNo

Which Degree/Certification are you seeking (Required)EMS AS DegreeParam-TEMT-ATD

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.

High School Address:

Did you graduate:YesNo

LICENSES AND CERTIFICATIONS

Type of Certification

Issuing State or Agency?

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.

Verification: (Required)

EMT Application

EMT Program Application