Personal Information  

First Name:

(required)

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: (required)
College: Hours Completed:
Degree: Year Graduated:
Other Education (describe):

Program Prerequisites
Are you currently a certified EMT?  Yes No
Have you completed the anatomy & physiology class? Yes No Grade N/AABCDWI
Have you completed the English Composition I class? Yes No Grade N/AABCDWI
Have you completed the English Composition II class? Yes No Grade N/AABCDWI
Have you completed the computer class? Yes No Grade N/AABCDWI
Have you completed a 3 hour ethics class? Yes No Grade N/AABCDWI
Have you completed a 3 hour psychology class? Yes No Grade N/AABCDWI
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 2013
18 Month Schedule - Andover - starts August 2013

I verify that all of the information provided is, to the best of my knowledge, accurate. I also acknowledge that a criminal record check will be required in the future before performing patient care.

*Incomplete applications will not be considered.

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

SUBMISSION: Submit this application and mail at least two letters of recommendation and a copy of your EMT certification. Mail this material to:

Chris Cannon
Department Chair, Allied Health
EMS Education Program Director
Cowley College
1406 E. 8th Street
Winfield, KS  67156
620.229.5985

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