EMT Application

EMT Application
Date Submitted

MonthDayYear
Thank you for your interest in the Wilson Community College Emergency Medical Technician (EMT) program. Please read and review all the information and requirements before you begin the application process.

GENERAL PROGRAM INFORMATION

Students must submit a completed application and meet all admission requirements.

NCOEMS PREREQUISITES AND WCC EMT REQUIREMENTS:
1. 17 years of age on or before the official end date of the course.
2. Possession of a high school diploma, high school equivalency, or successful completion of an exam assessing basic reading comprehension skills at a minimum of the eleventh-grade level.
3. For successful completion, students must maintain a 90% attendance rate.
4. Copy of a valid state-issued driver's license.
5. Proof of the following immunizations:
  - One (1) TB skin test completed within three (3) months of class start date or a negative chest X-ray within twelve (12) months of class start date
  - Proof of two (2) MMR vaccinations
  - Hepatitis B vaccination (documentation of at least the first dose of the three-dose series required)
  - Proof of varicella (chickenpox) vaccination or a titer (blood test) confirming immunity
  - Tdap, TD, or Tetanus vaccination within the last ten (10) years
  - COVID-19 vaccination requirements are determined by individual clinical sites
ASSOCIATED PROGRAM COSTS:
1. Registration fee, student accident insurance, and malpractice insurance per semester. (Registration fee only is waived for EMS, Fire, and Law.)
2. Level-specific textbook required with online access.
3. CPR card (based on current AHA card fee schedule) and current CPR book required.
4. EMCE Pro software for students.
5. Background check through Viewpoint Screening.
6. Required attire for program (see below).
7. State exam fee upon successful completion of the program.
REQUIRED ATTIRE:

Clinical dress code:
- Dark pants (black or blue)
- EMS program shirt
- Black shoes
- Black socks
- Black belt
*If you are a member of a Fire or EMS agency, you may wear your agency uniform.

*Short pants are not permitted.

Class attire requirements will be communicated on the first day of class and are at the instructor's discretion.

BEFORE YOU BEGIN, PLEASE HAVE THE DOCUMENTATION BELOW READY TO UPLOAD:
- State-issued driver’s license
- High school transcript, documentation verifying high school equivalency, or documentation of successful completion of an exam assessing basic reading comprehension skills at a minimum of the eleventh-grade level.
- TB skin test completed within three (3) months of class start date OR a negative chest X-ray within twelve (12) months of class start date
- Proof of two (2) MMR vaccinations
- Hepatitis B vaccination (documentation of at least the first dose of the three-dose series required)
- Proof of varicella (chickenpox) vaccination OR titer (blood test) confirming immunity
- Tdap, TD, or Tetanus vaccination within the last ten (10) years
- COVID-19 vaccination (optional)
I have my documentation ready.*

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Student Information
Name*

First NameMiddle NameLast Name
Mailing Address*

Address

Street Address Line 2

CityState

Zip Code
Cell Phone*
Home Phone
Email*
example@example.com
Last 4 digits of SSN*
Date of Birth*

MonthDayYear
Gender*
Race*
Please upload a copy of your state-issued driver's license.*

Accepted file types: .pdf, .doc, .docx, .jpg, .jpeg, .png
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Education and Employment Information
Upload your high school transcript, documentation verifying high school equivalency, or documentation of successful completion of a reading comprehension assessment exam.*

Accepted file types: .pdf, .doc, .docx, .jpg, .jpeg, .png
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Briefly describe your prior work experience.*
Describe your career objectives.*
Employment Status*
Job Title/Occupation*
Employer/Agency Name*
Employer/Agency Phone*
Format: (000) 000-0000.

Agreement
By signing below, I certify that I have attached/uploaded all required documentation as outlined under “WCC EMT Requirements.” I have read, understand, and agree to comply with the stated requirements of the EMT Program. I understand that this submission constitutes an application only and does not guarantee acceptance into the program. I further acknowledge that I have reviewed the required clinical dress code and agree to comply with those requirements upon acceptance into the program.
Signature
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EMT Application

Student Information

Education and Employment Information

Immunization Records

Agreement