EMT Application Form Page

Application deadline: August 1st or until the class is full.

Class Starts: September 7, 2022

Class Ends: December 15, 2022

Course days and times:

Monday, Wednesday, and Friday 6:00 P.M. to 9:00 P.M.

Saturday Full day.

*Time-dependent upon COVID restrictions.

Apply now

Application Deadline

Days

Hrs

Min

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Location:

Central Kitsap Fire and Rescue, Station 41

7600 Old Military Rd. NE, Bremerton, WA 98311

This is a very difficult course of study! The student should expect to spend a minimum of 3 to 4 hours of study time each day outside of the classroom. Students, who have not had higher than average academic success in the past, will find this course very difficult.

Student Prerequisites: must be attached to the application for the application to be complete and considered for the course. Applications are noted by the date received and the date of completion. Students may turn in an incomplete application to be noted for the class, however, will not be considered for a seat unless the application is complete. Class seats are given by the application completion date.

Before you start, read through the entire application and gather all your documentation. You will have several documents you will need to upload in order to complete your application. There are phone apps available to submit by the preferred pdf format. Applications may be submitted with incomplete documentation. However, applications are considered by date received, completeness, and if payment has been received.

First name *

Email address *

Middle Initial *

Phone number *

Last name *

Are you affiliated with a fire district?

** Please look at the EMT class page on what it means to be affiliated.

Bainbridge Island

Bremerton Fire

Central Kitsap

North Kitsap

Olympic Ambulance

Poulsbo Fire

South Kitsap

OTHER LICENSE EMS AGENCY OR FIRE DISTRICT

Other Affliation

what non-Kitsap County agency are you affiliated with?

T-Shirt Size (unisex) *

Please read the above instructions regarding each element below. Applications are noted by the date received and date of completion.

To START an application students must attach proof of the following:

Do you have a driver's license?

Students must be older than 18. If not, please contact office for information.

Yes

Do you have your Covid Vaccination Card?

All students must have received their COVID vaccinations.

Yes.

No.

Driver's License Verification *

Pdf are preferred. Only front is needed.

Choose File

COVID Card Verification *

Pdf are preferred. Only front is needed.

Choose File

Reason for no Covid Vaccination Card.

Application Items

To complete the application student must attach proof of the following below items. If the items are not attached at this time, please note when you anticipate turning in the documentation. Students are not granted a seat number until all items are complete.

BLS Provider CPR Card

This card MUST BE at a BLS provider level.

Yes

Not Yet

CPR Card Verification *

Pdf are preferred. Only front is needed.

Choose File

When do you plan to take your CPR class?

Graduation

: High School Diploma, or GED, College Transcript, College Diploma

Yes

Not yet

Graduation Verification

Pdf are preferred. Does not need to be official transcript

Choose File

When do plan to graduate?

Reading Comprehension

College Transcript with ENG 101, College Diploma, Accuplacer Exam placing in ENG 101

Yes, Accuplacer is attached

Haven't taken test yet

Using College transcript/diploma from above

Reading Verification

Pdf are preferred. Does not need to be official transcript

Choose File

NO reading info

Vaccinations

To complete the application student must attach proof of the following vaccines.

MMR (measles, mumps, rubella) vaccination or titer proof of immunity.
TB testing within the last year.
Tetanus vaccination within the past 10 years.
Hepatitis B vaccination.
Varicella vaccination or titer proof of immunity.
Current seasonal flu shot. (When it is available)

Immunization record

Please look at the list above of all immunizations which should be included. If you don't have some, please include information in text box.

Yes

I am attaching some and sending more.

Immunization Verification

Pdf are preferred.

Choose File

NO Immunizations

Partial immunizations provided

All students must pass a multi-state criminal background check prior to beginning any clinical or field rotation. Forms for the criminal background check must be completed with the application to be complete. These criminal background checks are performed by the Kitsap County EMS and Trauma Care Council. Please complete the background check packet and turn it in with your application.

Background Check Packet

Completed Background packet

Choose File

Each student will be required to attend an (8) hour Emergency Department rotation at St. Michael’s Medical Center – Bremerton.

Hospital Rotation Form

Completed Hospital Rotation Form

Choose File

ACCEPTANCE OF FINANCIAL RESPONSIBILITY

Please read the below CAREFULLY

Cost of the class *

I UNDERTSTAND THE $400 FEE FOR CLASS IS NON-REFUNDABLE AFTER BOOKS HAVE BEEN ORDERED WHETHER OR NOT I ATTEND THE CLASS.

TOTAL COST OF THE CLASS IS : $1400

Invoicing *

I understand invoices will be sent to the above email the day after the deadline.

I understand tuition must be paid in full two weeks before class.

I understand students who cancel or withdraws before the course begins, will receive a refund minus all fees/supplies ($400).

I understand students who withdraw during the first week of class, will receive 50% of the course tuition.

I understand no refunds will be given after the first week of class.

I understand *

A working lunch and snacks WILL NOT BE PROVIDED.

Students must follow all current COVID restrictions.

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