Request for Enrollment - Summer 2024 EMT Program 
This is the official Summer 2024 EMT Request for Enrollment. Filling this out does NOT guarantee you a slot in the program; it merely acts as a request for acceptance into the program. It is ultimately YOUR responsibility to take care of any holds on your record. The class is seated on a first-come, first-qualified basis and the only way to know if you're qualified is to be fully admitted to the college with all your transcripts and immunization records on file. A minimum number of candidates must qualify and be accepted into the program for the program to make. Accepted students will be notified in a timely manner if the course does not make.

Class will meet Monday through Thursday from 8:30-15:00 with 96 hours of clinical rotations taking place outside of normal class time.
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Last Name *
First Name *
Email address *
The email address that YOU check on a regular basis. 
Communication regarding program acceptance will be sent to this address.
A# [PREFERRED] or last 4 of SSN AND Middle Initial *
Your A# was issued to you by the college on admission.  If you do not have an A#, enter the last four digits of your Social Security Number.  Students are responsible for forwarding A# to EMT Coordinator promptly when received.
Phone Number *
YOUR phone number. Not your parent's or your friend's phone number - the one that you will personally answer when I call you.
County of Residence: *
Placement Testing Required? *
Are your ACT scores valid (less than 5 years old), do you have a college degree, or have you already attempted the Accuplacer exam?
Please select your highest level of education. *
I understand that I am requesting enrollment in an EMS Academy. This means that many aspects of the program are militant in nature. This will not be like any high school or college class I have taken before. This will help prepare me for the dynamic and uncensored environment I am entering into when responding to emergencies, and must perform under pressure because someone's life is in my hands.
 *
Final Note - Please read carefully. The EMS Academy is unlike anything you have ever encountered. We have worked hard to garner and maintain our reputation. If you stick with us, we will make sure you are the best. Whether you make it out or not, is up to you - your dedication, your commitment, and your hard work. Those accepted into the EMS Academy will be expected to conform to our high standards. We are here to work hard, have fun, and get the whole team through together - we will not lower the standards that we hold ourselves to.
  • Thank you for applying! You will be contacted by the EMT/AEMT Coordinator OR the Health Sciences office, and notified of any next steps that need to be taken. 
  • The EMT/AEMT Coordinator is the ONLY one who admits into the program. Refer any questions you have about your admissions directly to awatson12@columbiastate.edu. Please refrain from making multiple inquiries - I receive MANY emails. Your program acceptance letter will originate from this email address.
  • If you have a hold on your record, you will be contacted by the Health Sciences office ONE time and ONE time only. It is YOUR responsibility to let them know when you have completed the requirement to have a hold removed (Accuplacer testing, transcripts, vaccination records, Right Start Orientation, etc). 
  • If at any time you decide against attending the course you applied for, please email the above address with your regrets so that a position can be offered to the next applicant. No hard feelings! 
I have read the above in its entirety. I understand that this program will require 100% of my best effort in order to achieve success. If accepted, I am prepared to commit myself to this program for the duration of the semester. I understand that I can expect to receive the same effort from my instructors that I give them. *
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