UTD EMT Class Registration: Winter 2025 and Spring 2026

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Welcome to the University Emergency Medical Response Application! There are multiple parts of this application, and you must complete ALL parts in one sitting. You may not start the application and save for completion later.

To complete the application, you will be required to submit course payment by credit card or ACH. You may pay the fees in full ($1650) or you may pay half at registration ($825) and the remainder will be due one week before class starts. In order to complete the payment plan, you will need to use the word paymentplan prior to making payment. All payments are NON-REFUNDABLE. We are not able to accept scholarships, financial aid or grants.

If you have any questions, please email the EMS Director:

Sheila Elliott (sheila.elliott@utdallas.edu)
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Course Eligibility Questions:* This field is required.You must be eligible to take our EMT-Course. It is your responsibility to answer these questions truthfully. Answer these questions as they apply to the last day of the course. You must have graduated high school or be age 18 when you complete the course.
Please Select
Please Select
I have a high-school diploma / GED
I am working on a high-school diploma / GED, and understand that I cannot be an EMT without one.
I DO NOT have a diploma/GED.
High-School Diploma
Please Select
Please Select
I have no felony convictions
I HAVE a felony conviction
Criminal Background
Please Select
Please Select
I am at least 18 years old
I am/will be 17 on the first day of class, but my guardian(s) and I understand that I will be participating in the course, taking a drug test, will not be able to be a Texas EMT until I am 18, and that I will need them to sign consent forms.
I will be under the age of 17 on the first day of class.
Age
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STUDENT's Full Name* This field is required.Student Information
First Name
Last Name
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STUDENT's Email* This field is required.Student Information
example@example.com
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STUDENT's Cell Phone Number* This field is required.Student Information
Area Code
Phone Number
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STUDENT's Residential Address* This field is required.Student Information
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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Are you or will you be a student with another school? (UTD, UTA, etc,)Please type your school or write N/A.
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I have viewed the course schedule and understand that I must attend the in-person Lab Days. Attendance is MANDATORY as this is a course regulated by the state of Texas.* This field is required.
Yes
No
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I understand that I must spend at least 10 hours per week in addition to the Labs studying by myself, or with a group, for this course.* This field is required.
Yes
No
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I understand that the total cost of the course is $1650 which includes course tuition, immunization portal, course scheduler (Platinum Planner), random drug testing and background check.* This field is required.
Yes
No
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IMMUNIZATION PORTAL -* This field is required.I understand that I must upload ALL of my immunizations into the UEMR portal the week before class starts. I will begin this process early so I can ask my doctor or parents about my childhood immunizations and not delay in getting this information! This is SUPER IMPORTANT!!! Here is the list of requirements.
Yes
No
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I understand that I MUST have health insurance for the duration of the course. There are no exceptions for this requirement.* This field is required.
Clear
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DRUG TESTING - I understand that I will be given a random drug test during the course, which is a requirement by the hospital. As a medical provider, there is an expectation that you are drug free and you will remain drug free throughout the course. If you your initial drug test is POSITIVE, you MUST have a prescription for it. (Marijuana is NOT legal in Texas.) Other illicit drugs like cocaine, heroin, etc. are also not legal. If you fail the drug test, you will forfeit your tuition and be immediately dropped from the course. Please know you could be subject to additional drug tests throughout the course, if needed. The initial drug test is covered in you tuition. However, subsequent drug tests will be at your own expense.* This field is required.
Yes
No
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I understand that once I complete payment for the course, NO refunds will be given and switching to another class may not be an option.* This field is required.
Yes
No
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If you are using your parent's credit card to pay for this course, please let them know NOW that the charge on the statement will be from University Emergency Medical Response. It is VERY important that your parents are aware so they do not accidentally dispute the credit card charge when they see it. A disputed credit card charge causes a lot unnecessary work on our end. (Yes, this actually happens at least 1-2 times per semester.) You will be charged $50 if there is a dispute.* This field is required.
I understand
I do NOT understand
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I understand these classes fill up VERY quickly and to reserve a spot in the class, I must complete payment IMMEDIATELY after this form is submitted.* This field is required.
Yes
No
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I understand that for me to get licensed as an EMT, I must pass the National Registry Exam, which the course will prepare me for. I understand this is an additional cost, in addition to the TxDSHS license and fingerprinting process.* This field is required.
Yes
No
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I understand that this course will be SO AWESOME!* This field is required.
Yes
No
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Choose Your Shirt Size* This field is required.(Shirts are in MALE sizes and tend to run larger.)
XS
S
M
L
XL
XXL
XXXL
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Do you have a criminal record that would prevent you from receiving an EMS license in texas? (If you are unsure, check here: https://www.dshs.texas.gov/emstraumasystems/qicriminal.shtm)* This field is required.Background Check Information
Yes
No
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ID or Drivers License Number* This field is required.If you do not have a DL, you may use a government issued ID for the Background Check Information. if you do not have an ID or DL, then you can use your passport, social or any other identifying number that you have. For the next question where it asks for State, just put Texas.
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ID or Drivers License State* This field is required.Background Check Information
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Date of Birth* This field is required.Background Check Information
Date
Month
Day
Year
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Emergency Contact Name: * This field is required.Emergency Contact Information
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Emergency Contact Relationship:* This field is required.Emergency Contact Information
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Emergency Contact Phone Number:* This field is required.Emergency Contact Information
Area Code
Phone Number
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Name* This field is required.Liability Release
First Name
Last Name
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Effective immediately upon execution, I, named above, for and in consideration of the payment to me of EMT Course Tuition and related fees, the receipt and sufficiency of which is hereby acknowledged, do hereby release and forever discharge University Emergency Medical Response (UEMR), their agents, employees, successors and assigns, and their respective heirs, personal representatives, affiliates, successors and assigns, and any and all persons, firms or corporations liable or who might be claimed to be liable, whether or not herein named, none of whom admit any liability to the undersigned, but all expressly denying liability, from any and all claims, demands, damages, actions, causes of action or suits of any kind or nature whatsoever, which I now have or may hereafter have, arising out of or in any way relating to any and all injuries and damages of any and every kind, to both person and property, and also any and all injuries and damages that may develop in the future, as a result of or in any way relating to the following:

EMS Education / Clinical Internship under the University Emergency Medical Response entity.

Potential injuries arising from the UEMR EMS Education program may include but are not limited to: Serious Bodily Injury, Exposure to Disease and bloodborne pathogens, Psychological trauma. Exposure to COVID-19 during either clinical or classroom/lab activities could be likely and by signing below you understand this risk.

It is understood and agreed that after payment is made and received in full and complete settlement and satisfaction the causes of action, claims and demands mentioned herein; that this Release contains the entire agreement between the parties; and that the terms of this agreement are contractual and not merely a recital. This Release may not be altered, amended or modified, except by a written document signed by both parties.

Furthermore, this Release shall be binding upon the undersigned, and his respective heirs, executors, administrators, personal representatives, successors and assigns. This Release shall be subject to and governed by the laws of the State of Texas.

This Release has been carefully read and fully understood by the undersigned. The terms have been explained to me and I am freely, knowingly and voluntarily entering into this Release.
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By my signature below, I acknowledge I have read and understood the release of liability for the EMT Course.* This field is required.Liability Release
Clear
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I acknowledge I have received a copy of the UEMR Course Policies, and have read them in their entirety and agree to all policies. I also agree and acknowledge that failure to adhere to course policies may result in my enrollment being terminated without refund. I also understand that If I fail the course, or decide to withdraw at any point, no refund will be given.* This field is required.Course Policies Agreement
Yes I acknowledge and agree to the above statement.
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I give permission for UEMR and its agents to take photos of me during my time in the course and agree to have them posted to Agency Related social media. I understand that I am able to approach an instructor and ask that a picture not be shared without any issue.* This field is required.Course Policies Agreement
Yes, I give permission for photo / video to be taken of me during the course
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Signature* This field is required.Course Policies Agreement
Clear
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Do you have any physical limitations that would prevent you from being able to lift, turn or transfer patients? If yes, please describe below. If no, just answer "no".
Huge
Large
Normal
Small
Ok
Ok
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Do you have any limitations in the use of your senses such as sight, smell, sound that would limit you from practicing as a healthcare professional? If yes, please describe below. If no, just answer "no".
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Large
Normal
Small
Ok
Ok
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Do you have any other health conditions that would prevent you from being a healthcare professional? If yes, please explain, if no, just reply "no"
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Small
Ok
Ok
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HLTH 4304 is an optional course that you may enroll in concurrently with the EMT course in order to earn 3 academic credits. You will have to pay UTD tuition on top of UEMR course tuition. Please see this document regarding HLTH4304 information:

HLTH 4304 Information

IMPORTANT: This option is not available to UTA students.
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Are you planning to enroll in HTLH4304?
YESNO
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What is/was your major in college? * This field is required.If you are not in college and have never completed a degree please enter N/A.
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By my signing below, I agree to the following: (1) Once course payment is submitted, no refunds shall be issued. (2) Further course fees such as textbooks and uniform pants may be required throughout the course.* This field is required.
Clear
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Which class are you interested in enrolling in?The class you select here will change which page the form sends you to. Please select the course that fits your schedule the best. Winter classes begin in December. Spring classes begin in January.
December Academy, M-F 7:30 -4:30PM
Winter HYBRID EMT, M/W/F 6:00 -10:00PM
Spring 2026 UTD Section 1, Mon 2:30 -5:30PM
Spring 2026 UTD Section 2, Mon 6:00 -9:00PM
Spring 2026 UTA Section 3, Sun 3:00 -6:00PM
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On the next page, you will be directed to Pay for the course. Keep in mind that you are required to pay for complete registration. Payment will be complete through either Bank Transfer (ACH) or Credit/Debit Card.

Remember, the charge on your statement will be from UNIVERSITY EMERGENCY MEDICAL RESPONSE. If you are using your parent's credit card, tell them NOW there will be a charge from UNIVERSITY EMRGENCY MEDICAL RESPONSE. Tell them NOT to dispute this charge! (Yes, it actually happens about 1-2 times per semester.)
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Unfortunately, based upon your responses you are ineligible to apply for the EMT course.

Please contact the EMS Director for further questions. Email: sheila.elliott@utdallas.edu
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