There is a non-refundable, non-transferable application fee of $15.00. The fee is $20.00 if applying in person during regular registration or $25.00 if applying late. This can be paid online after you submit your application, by phone using a credit card, mailed to us, or paid in person during registration. Your application will not be reviewed until we receive your application fee.
Once you submit your application and we receive your fee, your application will be processed and you will receive email notification of your admission status from our office.
PLEASE NOTE
By applying for this course you are certifying that:
- have read the Course Information Packet
- understand the nature and scope of the course you are applying for
- meet all course prerequisites
- understand the immunization and course completion requirements
Contact us at admissions@lifesavercourses.com if you have any questions before you apply.
Type your name below to sign your application.
SECTION 1
COURSE INFORMATION
Applying to what course:
Enrolling as:
How did you hear about this course?
SECTION 2
APPLICANT INFORMATION
Last Name:
First Name:
Mailing Address:
City:
State:
Zip Code:
Drivers License Number:
Issuing State:
Social Security Number:
Date of Birth:
Sex:
Home Telephone Number:
Daytime Telephone Number:
Email Address:
Have you ever been given deferred adjudication or been convicted of a felony or misdemeanor (for other than traffic violations under $500)?
Do you have a disability that you will seek an accommodation for?
SECTION 3
EDUCATION AND TRAINING
Do you have a high school diploma or GED?
If Yes, which do you have?
When did you obtain your diploma or GED?
If you have a diploma, where did you graduate?
What is your highest education level?
Do you have a current professional healthcare provider CPR completion card?
If yes, who issued?
Do you have any previous medical training?
If yes, what?
Have you enrolled in an EMS course before?
If yes, what Training Program?
If yes, did you complete the Training Program?
SECTION 4
SKILLS AND QUALIFICATIONS
Summarize any special training, skills, licenses and/or certifications that you hold.
SECTION 5
CHARACTER REFERENCES
Name of a person known by you but not related to you:
That person's phone number:
SECTION 6
ADDITIONAL INFORMATION
List special accomplishments, publications, awards, etc you would like us to consider. State why your interested in attending an EMS course and list any additional information you would like us to consider:
SECTION 7
DISABILITY ACCOMMODATION
If you will seek a disability accommodation please briefly state your disability and the expected accommodation. Further information may be required. You will be contacted if we have further questions.
SECTION 8
CRIMINAL HISTORY
If you have ever been charged with a violation of the law which resulted in, or if still pending, could result in, probation, community service, a jail sentence or the revocation or suspension of your driver's license (including traffic violations which resulted in a fine of more than $200) complete this section. Include the following information for each offense:
Date of Offense; type of offense; court of jurisdiction and disposition of the case.
SECTION 9
STUDENT ACKNOWLEDGMENT
I represent and warrant the answers I have provided in this application are true and correct to the best of my knowledge. I understand that if I supply false information on this application, I will be involuntarily withdrawn from the EMS Academy when the false information is discovered, regardless of my current status in the course and I agree that no refund shall be due me. I agree to be bound by the Honor Code, policies and regulations of the Academy. I agree to pay all sums as they become due. I give my permission for Lifesaver Education Courses, its agents or assigns, to conduct a background investigation relating to this application and I hereby release Lifesaver Education Courses and its agents or assigns from any liability or consequential damages resulting from such investigation. I understand that typing my name where indicated warrants my signature.
SECTION 10
SUBMIT APPLICATION
Use the submit button to apply to the LEC EMS Academy. Use the cancel to erase your application.
EMS Academy: Online Application
Onsite EMS Courses
