Emergency Medical Technician Program Course Application

Printable PDF application

First name

Middle name

Last name

Phone number

Email

Students Services documentation only:

Student demonstrates readiness for EMT 151 by:

1. Successful placement testing at the level of WR 121 and Math 70 or previous completion of these courses.
2. Demonstrated readiness by:
3. Date registered for class:

Forward completed application to Kasey Lanning, EMT Program Lead after student is registered for class(es). See course needs for EMT pathway, one year cert. or AAS ERO-EMT.

Student Requirements to Enclose in Application:

Provide documentation you (student) will be 18 years of age by class start date.

Provide copy of high school diploma or equivalent (diploma/transcript).

Provide a copy of a CURRENT American Heart Association (AHA) or American Red Cross Healthcare Provider Card (HPC).

Student understands they will need to begin to gather documentation for the following and provide during their first term:

• 2 step TB skin test (T-spot and Quantiferon Gold are acceptable)
• Vaccines:
  • MMR (series of 3)
  • Varicella (series of 2)
  • Tdap (booster within 10 years—must have pertussis)
  • Hepatitis B (series of 3)

*Students will be required to submit to a 10 panel urine drug screen and criminal background check during their first term of the program. Information will be provided on the first day of class.

Complete and submit completed application including copies of student requirements to admissions@klamathcc.edu, or drop off at: Admissions (Building 9, 7390 S. 6th Street, Klamath Falls, OR 97603).