EMS Adm and Medical Disaster Mgmt Application

Please take the time to fill out the whole application and upload all necessary documents.

 

 

Date  
/ /   :
Personal Information
Primary Contact Phone Type



Secondary Phone Contact Type



Tertiary Phone Contact Type



Have you ever been convicted of a crime?  
May we contact your employer?  
Has your driver's license ever been suspended?  
Do you have an EMS Credential? If so, what level and what state issued it?  

Thank you for applying to the EMS Administration and Medical Disaster Management Training program. Once your application is received, you will be notified if you are approved and what discounts you qualify to receive. Receipt date of your application will be the date used to determine discounts and deadlines. At that point, your price will be locked in for 30 days.