Denton EMS Application

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PLEASE READ PRIOR TO COMPLETING APPLICATION.

• All tuition and fees paid by the applicant shall be refunded if the applicant is rejected by the school before enrollment.
• An application fee of not more than $25.00 shall be retained by the school if the application is denied.
• All tuition and fees paid by the applicant shall be refunded if requested within 3 business days after signing a contract
with the school.
• All refunds shall be returned within 30 days.
• Once 3 business days have elapsed no refunds will be given.
• Check or money order made payable to Denton Township EMS. Any payment arrangements must be made with I/C
prior to first night of class.
• Any Payments may be sent to Denton Township EMS or bring to class.

P.O. Box 289
Prudenville, MI 48651

Email *

Last Name *

First Name *

Street Address *

City *

Zip *

Email address *

Phone Number With Area Code *

Birth Date *

YYYY

SdaacdtyHighest Grade Level Completed *

Have you ever been convicted with a misdemeanor or felony; or are you currently being charged with either? *

Current Level of EMS Licensure *

If yes, please explain.

I attest that all the items I have provided are true to the best of my knowledge. I understand that if any items are untrue or if I have purposely provided false information, I will forfeit any monies paid and may be removed from the program at the discretion of Denton township EMS. My typed signature and date of birth signify my acceptance of this statement. You must type your name and your date of birth to accept this statement.

A copy of your responses will be emailed to the address you provided.

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