ACADemy Online EMT Application

ACADemy Online EMT Enrollment Application
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Men’s and Women’s sizes are available, please make sure to indicate if you want men’s or women’s sizing.
If yes, please attach a separate page giving a brief description of the incident. Include dates and penalties assessed.

EMERGENCY CONTACT INFORMATION

Required Enrollment Documents

Drop a file here or click to upload Choose File
Maximum upload size: 20.97MB
Drop a file here or click to upload Choose File
Maximum upload size: 20.97MB
Drop a file here or click to upload Choose File
Maximum upload size: 20.97MB
Acceptable documents include: high school diploma, high school transcripts, college transcripts (MUST have high school name and graduation year on them), GED certificate. We cannot accept college diplomas or college transcripts that do not have the high school name and graduation year listed
Drop a file here or click to upload Choose File
Maximum upload size: 20.97MB
Please follow the prompts for the online payment and pay in full or make the initial 3 part payment. Please Save your receipt and attach it here for proof of payment.

I understand that falsifying any records pertinent to this application can lead to ineligibility or immediate dismissal from the program. My signature below attests that the information contained on this application is true and accurate to the best of my knowledge. I also understand that I will have access to a digital copy of the textbook, but will not receive a “physical” text. If I would like to purchase one I can use the below link to do so:

http://www.jblearning.com/cart/Default.aspx?bc=08017-9&ref=psg&coupon=PSGQ119
I certify that the PRINTED NAME below is my ELECTRONIC SIGNATURE.

Protected: Protocol Reformat

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Protected: Protocol Update – ACAD Protocol 602 – Interfacility Tranfer of Incuded Hypothermia Pt

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Protected: Protocol Update – 603 Inter-facility Management of Hypertension (Round 2)

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Protected: Protocol Update – 100 General Principals

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Protected: Protocol Update – 601 Inter-Facility General Provisions

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Protected: Protocol Update 455 – Pain Control

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Protected: Protocol Update 227 – Trauma Patients

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Protected: Protocol Update 603 – Inter-Facility Induced Hypothermia

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Protected: Update Protocol 600 – Inter-Facility Transfer

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