EMT 2018-2019 Application
Please fill out all of the information. Please be advised, even though you have applied, not all applicants will be accepted based on limited class size. EMT is a rigorous adult level training program, 6 hours of concurrent credit through Weber State University is available to those who successfully complete this course. By industry requirement, you must be 18 by September 10, 2019 to take this class as a Senior. Applications need to be completed by April 30, 2018. You will receive your starter packet in the mail to the address you specify on this form if you have been accepted into the class. Contact Sadie Riel at sriel@graniteschools.org with questions. This course requires a TB test, fingerprinting, and participation at the hospital will require 2 step TB test, current immunizations with flu shot, and drug screen prior to clinical hours. This is the same requirement for any adult medical program.
Email address *
First Name *
Your answer
Last Name *
Your answer
Birthdate (ex: 07/20/2000) You must be 18 by Sept. 10, 2019. This is the Fall after you graduate. *
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Phone Number - Where you can receive text. *
Your answer
Student Number *
Your answer
Home School *
Your answer
Cumulative GPA *
Your answer
Email Address - Needs to be checked regularly! *
Your answer
Home Address - If you have been accepted into the program, you will receive a packet in the mail by beginning of June 2018 to this address. *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Previous Medical Classes Taken *
Your answer
Why would you like to be an EMT? *
Your answer
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