ARS Summer EMT Application

ARS Summer EMT Application

This application is for our summer EMT class starting July 10th and meeting every Saturday until October 2nd. This application will not guarantee you a position in the class. This application is your chance to tell us why you're the right person for this class. We will contact you directly to let you know about your enrollment.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Date of Birth*

MonthDayYear
Date
YESNO
YESNOI have had my first shot and I am waiting for my second.
Please upload a photo of yourself for your STUDENT PHOTO ID.*

Cancelof
XsmallSmallMedLargeXLXXLXXXLXXXXL
Agency Affiliation and Affirmation Acknowledgement.

Please complete this section based on your primary affiliation with an EMS provider. We're also asking for you to tell us more about you. Please be as detailed as you can.
YESNO
Please list your primary EMS agency.
If you are not affiliated with an EMS agency, please leave this section blank.
What is your current role with the listed agency?
Why do you want to take this course?*
How do you see yourself applying this course and information to your goals after completing this class?*
Yes, I will complete all my quizzes and reading before class.No, I will show up to class and not be prepared for the day.
ABSOLUTELY! I will be at class and ready to start at 8am every Saturday!No. I will be late to class and only be there for the fun stuff.
YES. I am an adult and can feed myself when required.YES. And I will bring extra snacks for others.I may forget my lunch and snacks but understand I might get cranky.No. I can only function with runs to the store every 30 minutes.
YES. And I understand I will be asked to leave this class if I smoke on campus.NO. And I understand I will be asked to leave this class if I smoke on campus.
Requirements to take this course.

This course requires you to have a select number of certified skills. We will ask you to upload verification of the skills and that they are current.
YESNO
Please upload your supporting documents for FEMA ICS.*

Cancelof
YESNO
Please upload your supporting documents for Basic Life Saving CPR/AED.*

Cancelof
**Here is the link for more information about NREMT policies. https://nremt.org/Policies/Certification-Policies/Certification-Eligibility,-Discipline,-and-Appeals

**Here is the link for more information about Vermont EMS policies. https://www.healthvermont.gov/emergency-preparedness-ems/emergency-medical-services/licensing
By signing this you agree to: The State of Vermont and the National Registry of Emergency Medical Technicians (NREMT) require that you report criminal convictions, substance abuse, loss of a professional licenses, and owed taxes, child support, or other funds that you are not currently compliant in repaying. These reports are viewed on a case-by-case basis for eligibility for registration and licensure.
Should be Empty:

ARS Summer EMT Application

Agency Affiliation and Affirmation Acknowledgement.

Requirements to take this course.