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* 1. Applicant Information

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* 2. Email Contact

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* 3. What class are you applying for?

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* 4. Emergency Contact Information

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* 5. Has your certification or authorization to practice ever been revoked or suspended?

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* 6. Have you ever falsified training records or requirements related to EMS Certification?

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* 7. What is your current level of EMS Certification?

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* 8. EMT Certification Information

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* 9. How long have you been an EMT?

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* 10. Do you have a high school diploma or GED?

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* 11. Advanced Education

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* 12. Please use the space below to answer the following question:
Why would you be a great candidate for our Paramedic Program?

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* 13. What would be your largest challenge in completing a Paramedic Program?

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* 14. Please indicate YES to the following statements as confirmation of understanding.

  Yes No
I understand that this program requires me to act professionally at all times.
I understand that this program requires me to be on-time for all of my classes.
I understand that this program requires me to be on-time for all of my clinical rotations.
I understand that this program requires me to be on-time for all of my field shifts
I understand that this program requires me to be subject to criminal and / or background checks, the results of which may affect my admission and / or continued participation in this program.
I understand that this program prepares me for licensing and / or credentialing as paramedic, but it neither licenses or certifies me as a paramedic.

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* 15. You will receive a call or email you to schedule an interview.

If you are accepted into the paramedic program, you will receive instructions for tuition payment. Your options are to pay the tuition in full prior to the start of the class or to pay the required deposit and enter our FACTS system, for a tuition payment plan.

We accept cash, personal checks, money orders, and all major credit cards.

When arriving for your interview, please bring with you all photocopies of applicable certifications, a copy of your drivers license, one professional reference and one letter of recommendation.


First Response Emergency Medical Education does not discriminate on the basis of race, creed, color, sex, age, nationality, or sexual orientation.

I hereby attest and affirm that I am committed to this Paramedic program and will make sufficient time available for its completion. I attest that I will pay all fees and tuitions incurred by myself while enrolled in this program as specified by my financial agreement. I also attest to the fact that all information provided by me is true and correct to the best of my knowledge. Any attempt to offer incorrect or fraudulent information will result in immediate withdrawal of this application, termination from the program, and forfeiture of future program acceptance.


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