CMH EMS Education Application Form
The permanent link to this form is
A lot of good info can be found on our website to answer your questions about EMS classes at CMH. Or you can email
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Student vaccination requirements:
Please refer to
for flu shot and COVID vaccination requirements for students.
Your first name:
Your last name:
Your email address (this is our primary means of communicating with students):
Agency you belong to (not required but helpful):
Your cell phone number with text messaging (this is our secondary means of communicating with students) [optional]:
Which course are you enrolling in?
Academy - Emergency Medical Responder (EMR)
Academy - Emergency Medical Technician (EMT)
Academy - EMT Internship
Academy - Paramedic
Academy - Community Paramedic
NAEMT - Advanced Medical Life Support (AMLS)
NAEMT - All Hazards Disaster Response (AHDR)
NAEMT - Emergency Vehicle Operator Safety
NAEMT - Geriatric Education for EMS (GEMS)
NAEMT - Pre-Hospital Trauma Life Support (PHTLS)
NAEMT - Psychological Trauma in EMS Patients (PTEP)
NAEMT - Tactical Emergency Casualty Care (TECC)
Other - Competency
Other - EMS Instructor
Other - Hazmat Medic
Other - Not Listed
If you pick "Other - Not Listed," above, what is the name of the course?
What is the start date of the course?
What is the start time of the course?
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