Emergency Medical Sciences Application

Full Name:

Student ID or Social Security Number:

Date of Birth:

Address:

City:

State:

Zip Code:

Phone:

Email:

Arkansas EMT#:

National Registry#:

American Heart Association Basic Life Support expiration date (no substitution):

Previously attended an EMT or paramedic program?

Yes

No

If yes, location(s) attended:

Reason left?

Certificate of Proficiency in Emergency Medical Science Technology (Spring Entry)

Monday/Wednesday afternoon course (1-4:30 p.m.)

Tuesday/Thursday night course (6-9:30 p.m.)

Certificate of Proficiency in Emergency Medical Science Technology (Summer Entry)

Monday/Wednesday day course ( 9 a.m. - 4:30 p.m.)

Certificate of Proficiency in Emergency Medical Science Technology (Fall Entry)

Monday/Wednesday afternoon course (1-4:30 p.m.)

Tuesday/Thursday night course (6-9:30 p.m.)

Paramedic and Associate EMS Programs:

Technical Certificate in (EMS) - Paramedic – Fall Entry day program (full-time *Requires Arkansas EMT license)

Technical Certificate in (EMS) - Paramedic – Fall Entry night program (full-time - Two nights each week *Requires Arkansas EMT license)

Associate of Science in Emergency Medical Science (EMS) - Paramedic *Requires Arkansas EMT license