Chicago EMT Training EMT Class Application

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Thank you for your interest in the EMS-200, Emergency Medical Technician course, Summer 2023!

-This course is operated as a online/in-person hybrid

-Lectures will meet 1-2 times a week and Labs will meet 1-2 times a week depending on the week

-There is only one lecture session, that meets Mondays and some Wednesday evenings from 4-8p

-YOU ARE REQUIRED TO ENROLL FOR A HANDS ON LAB SESSION-there are multiple times.

-ALL LECTURES WILL BE CONDUCTED ONLINE. You will need a computer, access to internet, and a webcam. We will be using Webex, there is no additional charge for the program.

-Labs will be hosted, IN PERSON, at our physical location-2054 w Cermak Rd. Chicago IL. There is FREE street parking on Hoyne. Be aware of permit parking on some blocks.

-This course will also require you to complete a minimum of 32 hours of clinical rotations. These are completed at different clinical settings, outside classroom time.

-This application cycle will be conducted on a rolling admissions basis.

-Applications will be first reviewed 3/20, after, applications will be reviewed each Monday.
Upon review of your application, you will be sent an email with an application decision and more information about 'what to do next'.

-Application should be finished in one sitting

If you have any questions, email the lead instructor, Martin Walsh, at mwalsh@chicagoemttraining.com

Email *

Before continuing with the rest of the application, please check the box next to each statement to confirm you understand and agree with it: *

I understand that completion of this course DOES NOT grant an EMT license, but rather the required hours and training to be eligible to take the National Registry of Emergency Medical Technician certification exam, which is a requirement of Illinois Licensure.

I understand that to successfully complete this course, I must obtain an 80% or higher overall and not miss more than 12 hours of class.

I understand the course fee is set at $1200.00, and there will be no seat saved for me in the class until that fee is paid.

I understand my application will not be reviewed until the $50 application fee is paid. (note-this application fee goes towards the $1200.00 tuition)

I understand that in addition to the class fees, this course requires a $115.00 text book and access code, a CPR training manual, a student uniform, a blood pressure cuff, a penlight, and a stethoscope

Chicago EMT Training will only evaluate course refunds if the refund is requested within the first two weeks of your class. Course refunds will not be provided to those in violation of the payment requirements.

In order to request a refund, an email must be sent to both Victor Chan (vchan@chicagoemttraining.com) and Martin Walsh (mwalsh@chicagoemttraining.com) titled “Refund Request: Last Name, First Name”. No other form of refund request will be considered, vetted, or approved.

We understand that there are sometimes extreme circumstances that pull students away from the class for longer than the allotted 12 hours of acceptable absence. In these events, Chicago EMT Training will review the reimbursement request. Reimbursement reviews take approximately 3 weeks to review and process.

ADMINISTRATIVE FEE ($200) will not be returned as an administrative fee for course registration.

I understand that as part of this course, there may be photos taken by Chicago EMT Training. If you do not want to be photographed (in which the phot may be found in future promotional material and on social media) please simply ask, and we will not photograph you.

I understand that if I miss more than 12 hours of class, for any reason, I will be dropped from the course without refund.

I understand that I am required to complete hours of clinical outside classroom time.

I understand the lecture dates are as follows: 5/8, 5/15, 5/17, 5/22, 5/30, 6/5, 6/7, 6/12, 6/19, 6/26, 7/5, 7/10, 7/12, 7/17, 7/19, 7/24, 7/31, 8/2, and 8/7 from 4-8p on Webex

I understand that I will have to attend a live lab session 1-2 times a week depending on the week.

I understand that the Illinois EMS Act requires me to have a Social Security Number to become a licensed EMT, and if I cannot provide a SSN, I cannot become an EMT per Illinois Law.

Required

Which online lecture session are you interested in? *

Mondays and some Wednesdays from 4-8p (5/8-8/7) online-Only option.

This option does not work for me

Which in person lab section are you interested in?

Tuesdays and Thursdays 8-11a (5/9-8/10) (waitlist)

Tuesdays and Thursday 2-5p (5/9-8/10) (waitlist)

Tuesdays and Thursday 5-8p (5/9-8/10) (wait list)

Saturdays and Sundays 9a-12n (5/14-8/14) (wait list)

Saturdays and Sundays 12n-13p (5/14-8/14)

Any of these options work

None of these options work

Clear selection

Course Schedule

Course Schedule pt 2

Course Schedule pt 3

Course Schedule pt 4

Course Schedule pt 5

First Name *

Last Name *

Date of Birth *

YYYY

Email Address *

Mailing/Home Address *

Polo Tshirt size?

XXL

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Have you ever taken an EMT class before? *

Yes

Do you have healthcare experience? *

Medical Assistant

Certified Nursing Assistant

Firefighter

Registered Nurse

Physician

Other

Are you a UIC Student? *

Yes

Are you in UIC's GPPA Program *

Yes

Are you a U of C student? *

Yes

Are you an IIT student? *

Yes

Are you a Northwestern University student? *

Yes

Are you a Loyola University Student?

Yes

Clear selection

Do you require any special accommodations in this class? If so what are they? If you do not need any accommodations leave this section blank.

Briefly describe your motivation for becoming an EMT. *

How did you hear about this class? *

Instagram

Facebook

Google

Word of mouth

College advisor

Other

Have you ever been convicted of a felony or misdemeanor, if so describe the circumstances. If this section is not applicable to you, you can leave it blank.

Emergency Contact Name

Emergency Contact Phone Number

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

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