Paramedic Education Program Application

In order to ensure an optimal student-to-instructor ratio, the Paramedic Education Program utilizes a selective admissions process to accept a maximum of 18 students per cohort. Factors contributing to the admissions process include EMS experience, life experience, references, an interview, and scores on entrance examinations. Final admission is contingent upon submission of all required documentation.

The application deadline is April 17, 2024.

Once accepted, a $1,500 non-refundable deposit is required to reserve your seat in the program.

A mandatory program orientation will be held for accepted students on Wednesday, May 1 at 6:00pm at Middlesex Hospital.

All fields are required unless otherwise noted.

Main Contact

First Name

First name is required

Last Name

Last name is required

Email is required

Phone

Phone is required and must be in 555-555-5555 format

Address

Address is required

Address (line 2) is required

City is required

State is required

Zip Code is required

Emergency Contact

Name

Emergency Contact Name is required

Phone

Emergency Contact Phone is required and must be in 555-555-5555 format

Relationship

Emergency Contact Relationship is required

Credentials

CT EMT Number

CT EMT Number is required

CT EMT Expiration Date

CT EMT Expiration Date is required and must be in mm/dd/yyyy format

CPR Certification Expiration Date

CPR Certification Expiration Date is required and must be in mm/dd/yyyy format

Attachments

Valid File Types: PDF, DOC, DOCX.

Resume/CV

Please provide your resume/CV. Valid Formats: PDF,DOC,DOCX.

EMT Certification

Please provide your EMT Certification. Valid Formats: PDF,DOC,DOCX.

CPR Certification

Please provide your CPR Certification. Valid Formats: PDF,DOC,DOCX.

NIMS 100 Certification

Please provide your NIMS 100 Certification. Valid Formats: PDF,DOC,DOCX.

NIMS 200 Certification

Please provide your NIMS 200 Certification. Valid Formats: PDF,DOC,DOCX.

NIMS 700 Certification

Please provide your NIMS 700 Certification. Valid Formats: PDF,DOC,DOCX.

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