Emergency Medical Technician (EMT) Application

Emergency Medical Services

Emergency Medical Technician (EMT) Application

"*" indicates required fields

First name*

Last name*

PCC email*

PCC ID number*

Education information

I have completed*

(check all that apply)

High school diploma

GED

College level coursework

List colleges attended below

If applicable, official transcripts are also required as described in the Plan your first term steps.

College/University

State

Dates of attendance

Unofficial transcripts

If you completed a prerequisite course (WR 115, RD 90 or MTH 20 - equivalent or higher) outside of PCC, please upload your unofficial transcripts here.

Accepted file types: pdf, jpg, jpeg, gif, png, Max. file size: 20 MB.

Please list the term you are applying for*

Term, year (Example: Fall, 2022)

EMS 105 (EMT Part I) Course application preference
Please list your first and second choice EMS 105 (EMT Part I) course preference below (second choice may be used if first choice becomes unavailable)

EMS 105 (EMT Part I) first choice CRN*

EMS 105 (EMT Part I) second choice CRN*

Immunizations, BLS, Background Check and Drug Test Requirements

I understand that once I submit this application, I am required to complete the following requirements through CastleBranch prior to placement into the program. I understand that there is a cost associated with each of these requirements. Failure to complete the following steps will make my application ineligible for admissions consideration. (Please see the EMT apply page and review the advising guide for more details.)

I will perform the following tasks through the CastleBranch system:

Complete and upload proof of my required immunizations ($20)

Complete and upload proof of my current American Heart Association Healthcare Provider or Basic Life Support (BLS) Card

Order and schedule a Background check ($51)

Order and schedule a Drug Test ($27)

I understand that failure to complete the above requirements prior to the start of my intended application term will make my application ineligible for admission consideration

Disclaimer

By electronically submitting this application, I acknowledge that PCC may be required to provide some of my student information to the Oregon Health Authority, EMS & Trauma Section, in order to process my EMT Course application. Additionally, I understand that some of my student information is necessary to be provided to NREMT and certain professional and clinical sites (hospitals, ambulance agencies, et. al.) for eligibility regarding required clinical components and national testing processes (e.g., criminal background check initiation and results, drug screen results, attendance information and, potentially, information about passing classes). I hereby give my consent to release information as needed.

Phone

This field is for validation purposes and should be left unchanged.