CE EMS Program Application

Fill out the form below.
Forms marked with * are required.

Program Selection

* Application for:

Contact Information

* First Name:

* Last Name:

Middle Name:

Birth_Date:

Address:

City:

State:

Zip:

* Phone Number:

Cell Phone Number:

* Email Address:

Prerequisites

**The Anatomy and Physiology course is not required for the AEMT Program, but is highly recommended.

High School Diploma or High School Equivalency?

NC or National Registry EMT Certified?

NC EMT "P" Number or National Registry Number:

Have you completed a college-level English Course (ENG 111 or equivalent) or taken a placement test within the last 12 months?

Have you completed a college-level Math Course (MAT 143 or equivalent) or taken a placement test within the last 12 months?

Successful completion of a Human Anatomy and Physiology Course.

Specify the Anatomy and Physiology Course you have completed.

Applicant Statements

Are you affiliated with an EMS Agency, Volunteer Fire Department, or Rescue Squad?

If you are affiliated with an agency, list the agency/department here:

Have you read the Paramedic Program Course Requirements and reviewed the online checklist?

Have you submitted the following documents to the Program Director via email?
Send required documents to Scott Shew at gshew4054@stanly.edu

*Copy of High School Transcripts or Diploma

*Copies of College Transcripts showing completion of college-level Math and English courses or copies of ACT Work Keys scores (Gold level or higher), or other approved placement test results that place you in college Math and English courses without a co-requisite. If you need more information about these options, please contact the EMS Program Director as soon as possible at 704-991-0186.

*Copy of Current NC or NR EMT Credential

*Copy of Current NC Driver's License

Applicant Comment:

CE Advanced EMT (AEMT) or Paramedic Certificate Program Application

CE EMS Program Application

Program Selection

Contact Information

Prerequisites

Applicant Statements