WEMT Training Application for Summer 2024
If you are interested in attending the WEMT Summer 2024 training, please complete the form below.

We have limited spacing, and will accept the first 24 students. We will continue to accept forms after the 24 have been reached to create a waitlist. Frequently, students who are interested decide not to continue and we work our way down the waiting list.


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Contact Information
List Options *
We will accept 24 applicants and 10 applicants for the waitlist. Some times we do have a lot of interest in the beginning, but still have spots to fill before the class starts.
Required
I understand I will need to attend orientation via Zoom from 6 pm to 8 pm on Monday April 24th. *
Required
First Name *
Legal First Name
Preferred First Name
Preferred Pronouns *
Examples, but not limited to: She/Her/Hers They/Them/Theirs He/Him/His Ze/Zim/Zirs
Middle Name
Last Name *
Street Address Line 1
Street Address Line 2
City
State
Zip Code
Email Address *
Preferred Phone Number *
Identification
Lane Community College L Number
If you are not or have not been a Lane student, you do not need to enter your L Number at this time.
Date of Birth *
Use MM/DD/YYYY format
Agency Affiliation
Agency is related to a city or rural fire agency only. If you are a volunteer, intern, or employee at an agency please enter the agency name.
Fee *
I understand this is a non-credit class that requires me to pay in full at the time of registration and does not qualify for financial aid. There are also hundreds of dollars in medical requirements, account fees, exam/licensure fees, and required equipment.
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