Application for EMT Training
To apply for an upcoming Emergency Medical Technician course. Please complete and submit the following application.

Personal Data

Name
Age
Home Phone
Message Phone
Email
Mailing Address
Street Address (if different)
City
State
Zip code
Shirt size
Course



Year

EMS Agency Data

EMS Agency Affiliation
Name of Fire Chief or Supervisor
Supervisor's Daytime Phone
Agency Mailing Address
Agency Email

Who will provide professional liability insurance and health insurance that covers the student?


Course Requirements

Please read through the list of Course Requirements below. You are required to turn in a copy (proof) of each item, to the EMS Office, at least one month PRIOR to class starting in order to have your application considered. In the event that your documentation has not been received by this time, your application may be denied without notice. Please utilize the links and forms provided for you below.

  • Copy of NIMS Certificates for IS-100.b, IS-200.b, IS-700.a and IS-800.b - all applicants
  • Copy of Current Driver's License or other photo identification. You must be 18 years old at the beginning of the course - all applicants
  • Copy of High School Diploma or GED, must have completed high school or GED before beginning of course - all applicants
  • Proof of Hepatitis B Vaccination series - non-affiliates only
  • Proof of 2 MMR Vaccine - non-affiliates only
  • Must have a history of chicken pox or have a Varicella titer - non-affiliates only
  • Proof of Rubella/Rubeola/Mumps titer - non-affiliates only
  • Copy of Health Insurance that covers applicant - non-affiliates only
  • Copy of Professional Liability Insurance - HPSO 1-800-932-9491, service@hpso.com, - non-affiliates only
  • Proof of background check performed by the Washington State Patrol - non-affiliates only
  • Proof of a drug screening performed by a certified lab - non-affiliates only

    Method of Payment

    The EMT course fee for non-affiliated (not active with a local fire department) individuals is $1,150. Make checks out to YCDEMS.


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