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Paramedic Program Application

Personal Information  

First Name:


Middle Name:
Last Name: (required)
E-mail Address: (required)
Home Phone Number: (required)
Cell Phone Number:
Address: (required)
City: (required)
State: (required)
Zip: (required)
Educational Background
High School:
Year Graduated:
Degree: Year Graduated:
Other Education (describe):
Program Prerequisites
Are you currently a certified EMT? 
Have you completed the anatomy & physiology class? Grade
Have you completed the English Composition I class? Grade
Have you completed the English Composition II class? Grade
Have you completed the computer class? Yes NoGrade
Have you completed a 3 hour ethics class? Yes NoGrade
Have you completed a 3 hour psychology class? Yes NoGrade
If you answered "no" to any of the previous questions, please explain:
Work Experience:
Describe your work experience, particularly any experience you might have in pre-hospital care, public safety or healthcare:
Program Schedule selection:

12-Month Schedule Winfield starts January 2016

Please click the submit button only once. It may take a few minutes for a confirmation message to appear.

SUBMISSION: After submitting this application please mail or email the following documents to the EMS Program Director:

  • Two letters of reference (typically from previous employers or instructors)
  • A copy of your current EMT or AEMT certification card
  • A copy of your NIMS/ICS certifications (if applicable)
  • A copy of your unofficial college transcripts


Submit the above to:

Chris Cannon, EMS Program Director
1406 E. 8th Street
Winfield, KS  67156


Official transcripts for high schools and colleges must also be sent to our registrar.


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