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EMT Program Application

EMT Program Application

Gulf Coast State College Emergency Medical ServicesApplication deadlines:

  • Spring Semester; October 20, 2017
  • Summer Semester; February 16, 2018
  • Fall Semester; May 18, 2018

EMS OFFICE CONTACT INFORMATION:

850-747-3234, Office
850-767-8211, Fax
Ms. Karen Tayes, email, ktayes@gulfcoast.edu
Rita Miller email, lmiller@gulfcoast.edu

Answer all Questions

APPLICATION INFORMATION

Gender:
Have you previously applied to the program? (Required)
Which Degree/Certification are you seeking? (Required)

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.

Did you graduate?

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Did you graduate?

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Did you graduate?

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Did you graduate?

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

Status:

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Status:

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Status:

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.

 
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