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Health & Human Services

Emergency Medical Services

 

CCEMTP Program Application

 

*Required Field

Personal Information

*First Name:

Middle Name:
*Last Name:
*Email Address:
*Home Phone Number:
Cell Phone Number:
*Address:
*City:
*State:
*Zip:
*High School Name:
*High School Graduation   Year:
Registration Type: Initial Renewal

Program Prerequisites

Are you currently a certified EMT-Paramedic or a licensed Registered Nurse? 
Are you currently CPR certified?
Are you currently ACLS certified?
Are you currently PHTLS, ITLS or TNCC certified?
Are you currently PALS, PEPP or ENPC certified? Yes No
Do you have at least one year of experience as a paramedic or nurse? Yes No
   
If you answered "no" to any of the previous questions, please explain:

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