Corona Virus

Your education is essential.
RC Health Services is labeled as an essential service during the COVID-19 outbreak. We are following all CDC-recommended procedures to mitigate the spread of COVID-19. We will remain open for you to get your certification so you can go back to work and help us beat this virus!
If you are experiencing signs and symptoms of COVID-19, do not come to class. We will reschedule you free of charge.

Corona Virus

Your education is essential.
RC Health Services is labeled as an essential service during the COVID-19 outbreak. We are following all CDC-recommended procedures to mitigate the spread of COVID-19. We will remain open for you to get your certification so you can go back to work and help us beat this virus!
If you are experiencing signs and symptoms of COVID-19, do not come to class. We will reschedule you free of charge.

American Heart Association Training Center

Emergency Medical Services Academy Program Admission Application

EMT Certifications are state specific, please select the state you are seeking to become an EMT in

Select the state:

You are urged to give careful consideration to each question on this form. It is to your advantage to fill out this form completely and return it promptly to: RC Health Services

Last Name:

First Name:

Middle Name:

Social Security #:

Date of Birth:

Address:

City:

State:

Zip:

Cell Phone:

Home Phone:

Work Phone:

Would you like to be contact by phone?

Yes

No

E-mail address:


Person to Notify in Case of Emergency:

Last Name:

First Name:

Relationship:

Home Phone:

Work Phone:


List information concerning high school, college and other schools attended:

Institution:

City/State:

Dates(From-To):

Degree Received:

Have you previously made admission to this program?

Yes

No

GED Certification?

Yes

No

High School Diploma?

Yes

No

Date of desired admission to this program:

Have you ever been convicted of a misdemeanor, felony, DUI or DWI or do you have any charges pending?

Yes

No

If yes, please attach a separate page giving a brief description of the incident. Include dates and penalties assessed.


I understand that falsifying any records pertinent to this application can lead to ineligibility or immediate dismissal from the program. My signature below attests that the information contained on this application is true and accurate to the best of my knowledge.

I certify that the PRINTED NAME below is my ELECTRONIC SIGNATURE.

Date:

Electronic Signature


Click here to upload a color copy of your US Government-issued photo ID.
Acceptable documents include Driver’s Licenses, State ID Cards, USA issued Passports and other Federal or State issued photo ID cards.



Click here to upload a copy of your US High School Diploma or GED Completion.
Acceptable documents include: US High School Diploma, High School transcripts (showing graduation), college transcripts which list High School name and graduation date, GED certificate, and foreign education Equivalency Evaluations showing equivalency to a US High School Diploma. We cannot accept college degrees or college transcripts that do not have the High School name and graduation year listed, or any education documents issued outside the USA.



Advanced EMT Students Only! Click here to upload a copy of your current NREMT EMT-Basic certification card.
You must scan the front and back of the card for it to be accepted.




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