Nederland Fire EMT School Application

Nederland Fire EMT School Application

You MUST have all required documentation in order to apply. Please refer to our website for a full list of requirements: https://www.nfpd.org/emt-emergency-medical-technician
Student Information
Name*

First NameLast Name
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
This email will be used for all course correspondence and MUST be checked regularly
Phone Number*
Please enter a valid phone number.
All applicants will be required to pass a background check prior to class acceptance. Background checks are sent via email after applications are received and must be responded to within five (5) business days or the request will be considered abandoned. If you have questions regarding this, please contact our office at (303) 258-9161 ext. 100 during business hours (Tues-Fri 07:00-17:00)
I am a current Nederland Fire volunteer*

YesNo
Affiliated Agency*
example: Boulder Fire

Student Documentation
BLS FOR HEALTHCARE PROVIDER CERTIFICATION

BLS FOR HEALTHCARE provider certification. It is imperative that you understand this must be a BLS FOR HEALTHCARE PROVIDER certification.

Accepted BLS Provider certifications: AHA, Red Cross, ASHI
BLS Provider Certificate*

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MMR

Proof of Mumps, Rubella and Rubeola immunity by positive antibody titers or 2 doses of MMR.
MMR Proof*

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INFLUENZA VACCINE

Influenza vaccines provided must fall within the same flu season as the course year.
Flu Vaccine Proof*

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HEPATITIS B

Proof of the full series of two or three doses or proof the series has been started within the last 30 days.
Hepatitis B Vaccination Record*

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Tdap (TETANUS)

Vaccination must have been done within the last 10 years and remain current throughout your time in the course.
Tdap Vaccine Proof*

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VARICELLA (CHICKENPOX)

Varicella immunity, by positive history of chickenpox or proof of Varicella immunization. You may also receive a Varicella titer blood test from your primary care physician.
Chickenpox documentation*

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To pay the application fee through the payment portal, you will automatically be re-directed after hitting submit. Choose "EMS Education" as your service type, hit continue and then select "EMT Application Fee - 50.00". The application fee is non-refunable but can be used towards your tuition if you are accepted to the class.
By hitting submit on this application, you will be re-directed to a payment portal and a $50 application will need to be processed before your application will be reviewed. You are also certifying that the information you provided is true and accurate.*

I certify that, to the best of my knowledge, the provided information is true and accurate and I am ready to pay my application fee.
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Nederland Fire EMT School Application

Student Information

Student Documentation