2024 FALL EMT Class Application
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First, Middle Initial, Last
Address
Please tell us your t-shirt size. They are uni-sex, short sleeve. The first T-shirt are included in your tuition. They are to be worn during your Saturday lab, and during field rotations.

Student Data Collection

Kitsap County is a Private Career School that is licensed and regulated by the Washington State Workforce Board.

Workforce requires that we ask you for this information, by law (RCW 28C.10.050). Providing your social security number is voluntary. By law, the information you provide on this form cannot be given out by any state agency as public information. The Workforce Board will not disclose data to anyone except authorized Workforce Board employees or contractors working on specific research activities, who follow strict confidentiality procedures. This format follows the information required to be submitted by the school as part of the annual student data report.

Race, Gender, and Veteran portion of the application is not mandatory to fill out to be accepted, however is appreciated.

Highest Grade Completed
Please supply either your HS diploma/GED and an Accuplacer result into ENG 101, or copy of your college transcript showing ENG 101, or final degree diploma.
Click or drag files to this area to upload. You can upload up to 2 files.
Please supply either your HS diploma/GED and an Accuplacer result into ENG 101, or copy of your college transcript showing ENG 101, or final degree diploma.

Supporting Documents

Applications are noted by taking of received and date of completion. Students may turn in an incomplete application to be noted for the class. However, they will not be considered for a seat unless the application is complete. Class seats are allocated by the application’s completion date. 

All students who participate in the Emergency Medical Technician – Basic course in Kitsap County must be at least 18 years of age at the time of class graduation.

Please provide your driver's license or state identification card.

Click or drag a file to this area to upload.

Part 1 of the BLS Provider CPR card. Purchase the following course https://shopcpr.heart.org/heartcode-bls and then provide the completion certificate with your application.

The second hands-on portion will be done in class.

Click or drag a file to this area to upload.
Please upload part 1 CPR certificate. This should have a IMP# on the bottom.

All students who participate in the Emergency Medical Technician – Basic course in Kitsap County must show proof of the following immunizations:

  • 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).
  • COVID Card
Click or drag files to this area to upload. You can upload up to 7 files.
At minimum your initial application should include your COVID card. Once you submit your application, the office will work with the student to turn in the rest of their vaccinations. The student may be eligible to receive a seat number once the application is complete and all the vaccine documentation is turned in.

All students must pass a multi-state criminal background check before beginning any clinical or field rotation. Forms for the criminal background check must be completed with the application to be complete. The Kitsap County EMS and Trauma Care Council or your affiliated agency will perform these criminal background checks. Please complete the background check packet and turn it in with your application.

Click or drag files to this area to upload. You can upload up to 17 files.
Please upload your complete background packet, which is found on the on the course information page.
Have you ever taken an EMT course before?

Contract Information and Agreement

Is an Fire or EMS Agency sponsoring your tution for this class?

Agreement

Course tuition includes the following:
• Hardback and electronic textbook
• Online learning platform
• T-shirt and stethoscope
• CPR Card Part 2
• National Registry Test Voucher

Course cost: $1700

The course cost for KCEMS-affiliated members: is $1600 with a multi-state background check included with the student.

Timeline of application and payment:

    • August 1st: This class is closed upon 24 complete applications. Applications will be accepted through August 1st for seats and the waitlist.
    • Billing: Invoices will be sent out through QuickBooks,once the class as 13 enrolled students, with a due date of August 1st. 
    • Supply Pick up: August 9th for all confirmed students with turned-in contracts.
  • Contract and bills will be sent out upon acceptance.

Payment should be by: Credit Card, Check, Money Order or Organization Purchase Order.

Cancellation/Withdrawal Policy: Please check the boxes below agreeing to the policy.
Please enable JavaScript in your browser to complete this form.
First, Middle Initial, Last
Address
Please tell us your t-shirt size. They are uni-sex, short sleeve. The first T-shirt are included in your tuition. They are to be worn during your Saturday lab, and during field rotations.

Student Data Collection

Kitsap County is a Private Career School that is licensed and regulated by the Washington State Workforce Board.

Workforce requires that we ask you for this information, by law (RCW 28C.10.050). Providing your social security number is voluntary. By law, the information you provide on this form cannot be given out by any state agency as public information. The Workforce Board will not disclose data to anyone except authorized Workforce Board employees or contractors working on specific research activities, who follow strict confidentiality procedures. This format follows the information required to be submitted by the school as part of the annual student data report.

Race, Gender, and Veteran portion of the application is not mandatory to fill out to be accepted, however is appreciated.

Highest Grade Completed
Please supply either your HS diploma/GED and an Accuplacer result into ENG 101, or copy of your college transcript showing ENG 101, or final degree diploma.
Click or drag files to this area to upload. You can upload up to 2 files.
Please supply either your HS diploma/GED and an Accuplacer result into ENG 101, or copy of your college transcript showing ENG 101, or final degree diploma.

Supporting Documents

Applications are noted by taking of received and date of completion. Students may turn in an incomplete application to be noted for the class. However, they will not be considered for a seat unless the application is complete. Class seats are allocated by the application’s completion date. 

All students who participate in the Emergency Medical Technician – Basic course in Kitsap County must be at least 18 years of age at the time of class graduation.

Please provide your driver’s license or state identification card.

Click or drag a file to this area to upload.

Part 1 of the BLS Provider CPR card. Purchase the following course https://shopcpr.heart.org/heartcode-bls and then provide the completion certificate with your application.

The second hands-on portion will be done in class.

Click or drag a file to this area to upload.
Please upload part 1 CPR certificate. This should have a IMP# on the bottom.

All students who participate in the Emergency Medical Technician – Basic course in Kitsap County must show proof of the following immunizations:

  • 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).
  • COVID Card
Click or drag files to this area to upload. You can upload up to 7 files.
At minimum your initial application should include your COVID card. Once you submit your application, the office will work with the student to turn in the rest of their vaccinations. The student may be eligible to receive a seat number once the application is complete and all the vaccine documentation is turned in.

All students must pass a multi-state criminal background check before beginning any clinical or field rotation. Forms for the criminal background check must be completed with the application to be complete. The Kitsap County EMS and Trauma Care Council or your affiliated agency will perform these criminal background checks. Please complete the background check packet and turn it in with your application.

Click or drag files to this area to upload. You can upload up to 17 files.
Please upload your complete background packet, which is found on the on the course information page.
Have you ever taken an EMT course before?

Contract Information and Agreement

Is an Fire or EMS Agency sponsoring your tution for this class?

Agreement

Course tuition includes the following:
• Hardback and electronic textbook
• Online learning platform
• T-shirt and stethoscope
• CPR Card Part 2
• National Registry Test Voucher

Course cost: $1700

The course cost for KCEMS-affiliated members: is $1600 with a multi-state background check included with the student.

Timeline of application and payment:

    • August 1st: This class is closed upon 24 complete applications. Applications will be accepted through August 1st for seats and the waitlist.
    • Billing: Invoices will be sent out through QuickBooks,once the class as 13 enrolled students, with a due date of August 1st. 
    • Supply Pick up: August 9th for all confirmed students with turned-in contracts.
  • Contract and bills will be sent out upon acceptance.

Payment should be by: Credit Card, Check, Money Order or Organization Purchase Order.

Cancellation/Withdrawal Policy: Please check the boxes below agreeing to the policy.