Supraglottic Airway Endorsement Course Application

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* 1. What is your first and last name as they appear on your DOH Credential?

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* 2. What is your Washington State Department of Health EMS Credential number?

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* 3. Which Mason County EMS agency are you primarily affiliated with?

NMRFA

District 3

District 4

CMFE

District 6

District 11

District 12

District 13

WMF

District 17

HFE

Olympic Ambulance

MCSO

Other (please specify)

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* 4. What is your email address?

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* 5. What is your phone number?

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* 6. Please check the boxes to acknowledge the following course completion requirements:

I have access to a computer or tablet and sufficient internet access to complete an online module.

I must complete both my online module and the in-person practical skill assessment during the course window to receive my SGA endorsement from the Department of Health.

Supraglottic Airway Endorsement Course Application

Question Title

* 1. What is your first and last name as they appear on your DOH Credential?

Question Title

* 2. What is your Washington State Department of Health EMS Credential number?

Question Title

* 3. Which Mason County EMS agency are you primarily affiliated with?

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* 4. What is your email address?

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* 5. What is your phone number?

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* 6. Please check the boxes to acknowledge the following course completion requirements:

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* 7. What are your goals for completing this training?