EMT class application

EMT Course Application
Full Name*

First NameMiddle NameLast Name
Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Email Address*
Phone Number*

Area CodePhone Number
Emergency Contact*

Area CodePhone Number
Name of Emergency Contact:*
Birth Date*

MonthDayYear

EMT Course Application
Level of Education*

GEDHigh school DiplomaSome CollegeCollege Degree
Why do you want to take this course?*
List any medical conditions, or learning disabilities that you feel course instructors need to be aware of:*
Are you able to pass a criminal background check?*

YESNO
Are you currently Law enforcement, Dispatcher, Volunteer Fire Fighter, or military?*

YESNO

Application and Course Instructions
After you click the "Submit" button your application will be sent to course administrators for consideration.

Discounted rate is given to military, local fire, law enforcement, and dispatch personel. Military ID must be presented the first night of the course for discount to be considered.

Course will begin March 8th, 2021 and will meet on Monday and Thursday nights from 6pm-10pm.

Classes will be held at Mid Mo Ambulance District office 221 S. Moreau Ave Tipton MO.

Course fee is $900 and includes course material and uniform shirt. Discounted rate is $800 for those listed above. Course fee can be broken into a payment plan with half required the first night of class and the remainder at a date set by course administrators. Check, cash, debit, credit cards are accepted.

Payment plan can be set up as follows: Half of the course fee payable on the first night of class with balance paid by June 1st, 2021.

Course fee does NOT include national testing fees which will be discussed at opening of the course.

GED or equivelent is required

Applicant must be able to pass a criminal background check.

This course will prepare the applicatant to test with National Registry of EMT's (NREMT). Once National Registry test is passed the applicant can apply for a EMT-Basic license with the State of Missouri.

*MidMo Ambulance District reserves the right to decline admission if any of the information provided is inaccurate or found to be untruthful.

Click the button below to submit this application:
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EMT Course Application

EMT Course Application

Application and Course Instructions