Supraglottic Airway Endorsement Course Application
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1.
What is your first and last name as they appear on your DOH Credential?
(Required.)
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2.
What is your Washington State Department of Health EMS Credential number?
(Required.)
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3.
Which Mason County EMS agency are you primarily affiliated with?
(Required.)
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?
(Required.)
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5.
What is your phone number?
(Required.)
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6.
Please check the boxes to acknowledge the following course completion requirements:
(Required.)
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.
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7.
What are your goals for completing this training?
(Required.)