2021 RCC Emergency Medical Technician Application
Per VCCS Policy 6.0.5, admission consideration is given to qualified applicants who are residents of the political subdivisions supporting the College and residents of those localities. Since enrollments are restricted for the EMS programs, admission consideration will be given to residents of the RCC service area first.
Contact the EMS Program Head for more information.

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Email *
Which semester are you applying for?
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Student ID# *
Last Name *
First Name *
Mailing Address *
What is your county of residence? *
Please provide your cell phone. *
Please check all that apply. *
Required
I have requested an official high school transcript or GED to be sent to RCC. *
Required
I have requested official non-VCCS college transcript(s) to be sent to RCC. *
Required
If you are a licensed healthcare provider. Please provide discipline and license number. Put N/A if not applicable. *
Students may choose one home campus, but it is not guaranteed. Students must be flexible in the event that course and clinical scheduling dictates a change in a campus location. Campus locations are not guaranteed. Campus assignment may change each semester, depending on student location and lab space. Please indicate which campus. * *
Criminal Background Check Statement—A criminal background check and drug screen are required for admission to the EMS program(s) as required by our clinical affiliates. If you have a criminal conviction you should contact the EMS Program Head to determine if your conviction will prevent you from enrolling in this program. I have read and understand this statement *
Student Accommodations Statement---EMS programs are committed to the policies set forth by RCC, the Virginia Office of EMS, and National Registry of EMTs regarding disabilities and reasonable accommodations. If you require special services or accommodations, you should contact the RCC Disability Services Counselor on either campus for an appointment at least 2 weeks prior to the beginning of classes if you are accepted into an EMS program. Your success is contingent upon your ability to fulfill the core competencies of the program. I have read and understand this statement. * *
All prospective students are required to be eligible to participate in all clinical facilities where we are contracted to provide clinical supervision. Students who are not eligible for rehire in any facility may be excluded from clinical experiences, and thus may forfeit their seats in the nursing program.                          I am a current employee or volunteer, in good standing, with an EMS agency. *
Please list which agency. Put N/A if not applicable. *
I am a former employee or volunteer, and left in good standing, with an EMS agency. Check all that apply. *
I am a current employee, in good standing, in a healthcare facility. *
Please check where you are currently employed. *
Required
I was a former employee of a health care facility and left in good standing. Please check all that apply. *
Required
Was employed in the medical field-Facility not listed. Please list facility. Put N/A if not applicable. *
I certify, under penalty of disciplinary action up to and including automatic withdrawal from the EMS program, that all the information is complete and accurate. I agree to supply the EMS program with supporting documentation related to my application if I am requested to do so. I further understand that submitting this application does not guarantee admission to an EMS program. Please sign using your full name. *
A copy of your responses will be emailed to the address you provided.
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