• Course Enrollment Application

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    Course Enrollment Application

    Course Details

    Course Information


    Personal Information

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    Student Acknowledgement of Prerequisites for EMS Training Certification

    Basic Life Support Program Enrollment (As of the start date of the Course)

    A. English Language Proficiency - I am proficient in reading, writing and speaking the English language.

    B. Minimum Age - I have reached the minimum age of 16 years of age. If I am less than 18 years of age, I have provided the Course Coordinator with an Office of EMS "Student Permission Form" signed by a parent or guardian verifying their approval of my enrollment in the course.

    C. Performance Ability - I have no physical or mental impairment which would render me unable to perform all practical skills required for this level of training.

    D. Cardio-Pulmonary Resuscitation - I hold current certification in an approved course in Cardio-Pulmonary Resuscitation.

    E. Criminal Convictions and Other Misconduct - I have not been convicted or found guilty of any felony or misdemeanor crime, offense or regulatory violation nor participated in any other prohibited conduct. This acknowledgement includes all of the prohibitions listed in the Virginia EMS personnel "Standards of Conduct" which have been provided to me by Course Coordinator.

    Advanced Life Support Program Enrollment - Includes all prerequisites listed for Basic Life Support Programs and the following additional requirements (As of the start date of the Course)

    F. Minimum Age - I have reached the minimum age of 18 years of age.

    G. Education requirement - I hold, at a minimum, a high school or general equivalency diploma.

    H. Performance Ability - I have no physical or mental impairment which would render me unable to perform all additional ALS practical skills required for this level of training.

    I. Current EMS Certification - I hold current EMS Certification as an Emergency Medical Technician. If I am enrolling in a "Bridge" course to a higher ALS level, I now either hold the required prerequisite lower ALS Certification or I am eligible to test for the lower ALS Certification level and understand that I must certify at that level before being allowed to test for certification for the higher ALS level of this new course.

        
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    Other Information

     
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