2024 Paramedic Application

2025 PARAMEDIC PROGRAM APPLICATION

Applications must be submitted online August 1, 2024, 9 a.m. until September 30, 2024, 4:00 p.m. PST
APPLICANT INFORMATION
Name*

First Name and Middle InitialLast Name
Have you fully and completely READ THE INSTRUCTIONS on completing this application? .*
Please select.
Do you understand that the submission of your application is part of the selection process and that applications that are incomplete and/or lacking verification will be discarded?*
Do you understand that applications cannot be changed once submitted? If you make an error, you must resubmit another, complete application.*
Do you understand that ALL the program requirements must be complete and final grades posted no later than October 31, 2024?*
Cuesta Student ID Number (begins with 900)*
Date of Birth*

MonthDayYear
Cuesta College e-mail address*
Secondary email*
Primary Phone Number*
Current Address*

Street Address

Street Address Line 2

CityState

Zip Code
Is your current address the same as your permanent?*
Permanent Address

Street Address

Street Address Line 2

CityState

Zip Code
How did you hear about the Cuesta College Paramedic Program?
1. HIGH SCHOOLS AND COLLEGES ATTENDED
What is your highest level of education?*
When and where did you receive your GED/Diploma or College Degree?*
Attach a copy of your high school or college diploma or GED certificate (a transcript is also acceptable but DOES NOT SUBSTITUTE for the official transcript that must be submitted to Cuesta's Admissions and Records department).*

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2. PREREQUISITE COURSEWORK
Have you completed all of your academic prerequisites?*
If you have an in-progress element, will it be completed and final grades posted by October 31, 2024?*

YesNo
Attach a copy of your unofficial transcript/registration showing the course in progress or to be completed and final grades posted by October 31, 2024.

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Are you submitting a college Placement Assessment test result in lieu of College Writing and/or College Algebra?*
Attach a College Assessment of your math and/or English skill

Upload a File

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PRE-REQUISITE COURSES COMPLETED WITH A ‘C’ OR BETTER (Include In-Progress courses):

	School	Course #	Term/Yr
Human Biology, Human Anatomy or Human Physiology (BIO 212, 205 or 206):
College Reading & Writing (ENGL 156) OR HIGHER:
Elementary Algebra (MATH 123) OR HIGHER:

Attach transcript(s) for your completed pre-requisites verifying your courses (including Cuesta courses). The attachment may be an unofficial transcript.*

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3. Work Experience
Do you meet the 1000-hour work experience requirement?*
Upload your employer statement(s) regarding work experience.*

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4. CURRENT CALIFORNIA EMT CERTIFICATION
Do you have a current California EMT Certification? Certification with the National Registry is NOT an acceptable substitute.*
Expiration Date:*

MonthDayYear
EMT Program Name:
City:
Upload a copy of your current EMT Card (BOTH SIDES). *

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5. CPR Certification

Please enter the expiration date of your CPR certification
Please enter the expiration date of your CPR card.*

MonthDayYear
Date
Upload a copy of your current Healthcare Provider's or Professional Rescuer's Basic Life Support certification.*

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APPLICANT ACKNOWLEDGMENT AND AGREEMENT
Signature*
Print name
Date*

MonthDayYear
--Make sure you use the option below to preview your form and check your answers. Subsidiary fields are often hidden and you will not see them if you answer the primary question incorrectly.

--Make sure you review the titles of your attachments and have attached the RIGHT document in the RIGHT place, and ALL the pertinent documents. REMEMBER: missing attachments will cause your application to be rejected. If you cannot attach a document, you may need to reduce the size of the document to meet document size limits. If you do so and it still will not upload, please contact Claire Hawkins at claire_hawkins@cuesta.edu or 805-592-9283.

--After you submit, take advantage of the option to download/save your application as a PDF, just in case. REMEMBER: If you don't get an acknowledgment, we didn't get your application.
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2025 PARAMEDIC PROGRAM APPLICATION

APPLICANT INFORMATION

1. HIGH SCHOOLS AND COLLEGES ATTENDED

2. PREREQUISITE COURSEWORK

3. Work Experience

4. CURRENT CALIFORNIA EMT CERTIFICATION

5. CPR Certification

APPLICANT ACKNOWLEDGMENT AND AGREEMENT