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Health & Human Services

Emergency Medical Services

 

Paramedic Program Application Form

 

*Required Field

 

Personal Information

 

*First Name:

Middle Name:
*Last Name:
*Email Address:
*Home Phone Number:
Cell Phone Number:
*Address:
*City:
*State:
*Zip:

Educational Background

*High School:

College:
Degree:
 
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


Verify

 

 

OTHER DOCUMENTS THAT MUST BE SUBMITTED:
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

BE SURE TO INCLUDE YOUR NAME AND CLASS APPLIED FOR WHEN SUBMITTING DOCUMENTATION.

 

Submit the listed documents above to:

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

620.229.5985

 

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