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Emergency Medical Services Education Course Pre-Registration Form

PLEASE REFER TO SPECIFIC COURSE(S) FROM CURRENT COURSE INFORMATION. YOU MAY ONLY SUBMIT FOR ONE COURSE AT A TIME!  A CONFIRMATION WILL BE SENT TO YOUR EMAIL TO CONFIRM YOUR PRE-REGISTRATION IN THE COURSE, BUT YOU ARE NOT "OFFICIALLY" REGISTERED IN A COURSE UNTIL YOU HAVE RECEIVED WRITTEN CONFIRMATION OF YOUR PLACEMENT BY US MAIL! YOU MUST ALSO DOWNLOAD AND COMPLETE AN OFFICIAL NYS APPICATION FORM . YOU MAY BRING THIS FORM WITH YOU ON THE FIRST DAY OF CLASS .

Student Information

Enter your home phone, or other number at which you can be reached in the evening.

Enter your mobile phone or other number at which you can be reached during the day.

Course Applying For - Refer to Current Course Offerings

Select the Level of the Course for Which You Are Applying.

Enter the type of course for which you are applying.

You will be registered for class during the next occurance of the semester you choose.

Please refer to curent course offerings for the schedule options available for your desired course.

Enter the class days of the course you are applying for (refer to current course offerings).

Refer to the current course offerings for the location of the course you are applying for.

Select Your Primary EMS Agency Affiliation (through which you are applying for this course).

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