Emergency Medical Service (EMS) Eligibility Request Form

Please select an course:

At this time, we do not have an EMR Course Scheduled

EMR Academy Interest Form

Please complete this form and submit it to the Davidson-Davie Community College EMS Program. For any inquiries, you can reach her via email at Leann_Pate@davidsondavie.edu or by phone at 336-249-8186, extension 6328.

EMR STUDENT PREREQUISITES:

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 at the tenth-grade level.

*If you need to complete the CASAS Test for placement in English, Leann Pate will contact you by email with that information.

Documents required to show eligibility for the EMR Program:

Driver's License
High School Diploma (or equivalent) **or** College Credit for English (transcript grade of C or higher) **or** CASAS Reading Score of Level 10.0

EMT Academy Interest Form

EMT STUDENT PREREQUISITES:

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 at the eleventh-grade level.

*If you need to complete the CASAS Test for placement in English, Leann Pate will contact you by email with that information.

Documents required to show eligibility for the EMT Program:

Driver's License
High School Diploma (or equivalent) **or** College Credit for English (transcript grade of C or higher) **or** CASAS Reading Score of Level 11.0

At this time, we do not have a Advanced EMT Inital Course Scheduled.

Advanced EMT Inital Academy Interest Form

1. Successful completion of an EMT Program (EMT Card or P#)

2. High School Diploma (or equivalent)

3. College Credit for English (transcript grade of C or higher) **OR** within the previous 12 months, complete a written assessment placing the individual into college-level English.

4. College Credit for Math (transcript grade of C or higher) **OR** within the previous 12 months, complete a written assessment placing the individual into college-level Math.

*If you need to complete the CASAS Test for placement in English and/or Math, Leann Pate will contact you by email with that information.*

Documents to show eligibility for the Advanced EMT Program:

Drivers License
EMT/AEMT Certification
High School Diploma (or equivalent)
College Transcript

At this time, we do not have a Paramedic Course Scheduled.

Paramedic Hybrid Academy Interest Form

1. Successful completion of an EMT Program (EMT Card or P#)

2. High School Diploma (or equivalent)

3. College Credit for English (transcript grade of C or higher) **OR** within the previous 12 months, complete a written assessment placing the individual into college-level English.

4. College Credit for Math (transcript grade of C or higher) **OR** within the previous 12 months, complete a written assessment placing the individual into college-level Math.

5. Successful completion of ONE of the combinations of courses by TBA:

EMS-2163: Basic Anatomy and Physiology
BIO-163: Basic Anatomy and Physiology
BIO-165 & 166: Anatomy and Physiology I & II (Must complete both sections)
BIO-168 & 169: Anatomy and Physiology I & II (Must complete both sections)

Drivers License
EMT/AEMT Certification
High School Diploma (or equivalent)
College Transcript
Anatomy and Physiology Completion Certificate/transcript

EMS Instructor Methodology Interest Form

1. Active credential as an EMT, AEMT, or Paramedic.
2. High School Diploma (or equivalent)

Documents to show eligibility for the EMS Instructor Methodology Program:

Active credential as an EMT, AEMT, Paramedic.
High School Diploma (or equivalent) and verify or demonstrate their ability to read and write at 11th grade proficiency level.

First Name

Middle Name

Last Name

Email Address

Mobile Phone Number

Birthdate

Mailing Address

Country

Street

City

Region

Postal Code

Are you currently affiliated with a Public Safety Agency?

Please provide the full department name of the Public Service Agency.

Are you a current or previous student at Davidson-Davie Community College?

Yes

Which EMT Academy are you more interested in?

Which EMS Instructor Methodology course are you interested in?

Please use the uploader below to upload any supporting documents

Driver's License

High School Diploma (or equivalent)

High School Transcript

College Transcript

Copy of Valid Certification

Copy of Valid EMT Certification

Copy of Valid EMT/AEMT Certification

Copy of Anatomy and Physiology Proof of Completion

REQUIRED TEXT & MATERIALS:

Emergency Care and Transportation of the Sick and Injured Digital Premier Package (Approx. $400) Purchase Options: (Student will choose one of the following text options) Please only purchase from the links below:

12^th edition premier (E-BOOK) with Internship package

http://www.jblearning.com/cart/Default.aspx?bc=23670-5&ref=psg&coupon=DAVIENC

12^th edition premier (PAPERBACK) with Internship package

http://www.jblearning.com/cart/Default.aspx?bc=23664-4&ref=psg&coupon=DAVIENC

2. “EMS Testing Emergency Medical Technician” (Approx $55) (Students will receive a code from the instructor after the class begins to purchase)

https://www.platinumed.com/ems/

3. Drug Screening and Background Check (Approx. $71). (This will be discussed on the first day of orientation)
(Prospective students of the EMS Program are advised that background checks and drug screenings must not be initiated before the official start of class. These requirements are part of the onboarding process and will be thoroughly explained during orientation. Any background check or drug screening completed before orientation will not be accepted.)

4. EMS uniform type blue or black pants, black belt, black boots with reinforced toe, and a Davidson-Davie Community College EMS shirt (purchase at the Thread Shed, 704-633-1159, approx. $35)

Predetermination Process

In accordance with N.C.G.S. § 93B-8.1(b6), individuals with a criminal history may petition The North Carolina EMS Disciplinary Committee (The Committee) for a predetermination process before starting or completing any mandatory education and/or training requirements. For more information, please visit https://oems.nc.gov/compliance/.

REQUIRED TEXT & MATERIALS:

Pick from one of the following book/platform options:

o Nancy Caroline, 9th edition Premier (physical book and Navigate access):

▪ http://www.jblearning.com/cart/Default.aspx?bc=25684- 0&ref=psg&coupon=DAVIENC

0&ref=psg&coupon=DAVIENC

o Nancy Caroline, 9th edition Premier digital (no physical book):

▪ http://www.jblearning.com/cart/Default.aspx?bc=25683-

3&ref=psg&coupon=DAVIENC

~AND~

● Complio Access (Background Check, Drug Screen, Document Management) [Approx $104]
(Prospective students of the EMS Program are advised that background checks and drug screenings must not be initiated before the official start of class. These requirements are part of the on-boarding process and will be thoroughly explained during orientation. Any background check or drug screening completed before orientation will not be accepted.)

● MyClinicalExchange (clinical rotation software) [Approx [$40]
(Prospective students of the EMS Program are advised that background checks and drug screenings must not be initiated before the official start of class. These requirements are part of the on-boarding process and will be thoroughly explained during orientation. Any background check or drug screening completed before orientation will not be accepted.)

~AND~

EMS Testing (Advanced EMT Level), [Approx $97]

~AND~

Davidson-Davie Community College EMS Education Polo Shirt [Approx $27]

• EMS uniform type blue or black pants, black belt, black boots with reinforced toe, and a Davidson-Davie Community College EMS shirt.

• The Thread Shed has all the uniform items needed at a discounted price. Address: 133 S Main St, Salisbury, NC 28144 Phone: (704) 633-1159

Predetermination Process

REQUIRED TEXT & MATERIALS:

Pick from one of the following book/platform options:

o Nancy Caroline, 9th edition Premier (physical book and Navigate access):

▪ http://www.jblearning.com/cart/Default.aspx?bc=25684- 0&ref=psg&coupon=DAVIENC

0&ref=psg&coupon=DAVIENC