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Paramedic Program Application

Personal Information      

First Name:


Middle Name:    
Last Name:     (required)   
E-mail Address:     (required)   
Home Phone Number:     (required)   
Cell Phone Number:    
Address:    (required)   
City:    (required)   
State:    (required)   
Zip:    (required)   
Educational Background    
High School:
Year Graduated:    
Degree:    Year Graduated:    
Other Education (describe):
Program Prerequisites    
Are you currently a certified EMT?     
Have you completed the anatomy & physiology class?     Grade    
Have you completed the English Composition I class?     Grade    
Have you completed the English Composition II class?     Grade    
Have you completed the computer class?       Yes   No Grade    
Have you completed a 3 hour ethics class?       Yes   No Grade    
Have you completed a 3 hour psychology class?       Yes   No Grade    
If you answered "no" to any of the previous questions, please explain:
Work Experience:    
Describe your work experience, particularly any experience you might have in pre-hospital care, public safety or healthcare:
Program Schedule selection:

  12-Month Schedule – Winfield – starts January 2016

Please click the submit button only once. It may take a few minutes for a confirmation message to appear.

SUBMISSION: After submitting this application please mail or email the following documents to the EMS Program Director:

  • Two letters of reference (typically from previous employers or instructors)
  • A copy of your current EMT or AEMT certification card
  • A copy of your NIMS/ICS certifications (if applicable)
  • A copy of your unofficial college transcripts


Submit the above to:

Chris Cannon, EMS Program Director
1406 E. 8th Street
Winfield, KS  67156


Official transcripts for high schools and colleges must also be sent to our registrar.

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