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EMT Pre-Registration Form

Thank you for your interest in the Emergency Medical Technician (EMT) program at Idaho CPR Plus.  

Please fill out this form in its entirety.  Answer all questions with an “*” 
 

We will contact you within 1 to 7 business days If approved and you will receive additional information and steps to complete your registration.  We may need to contact you for further clarification regarding answers on this form. If your application is rejected, we will notify you with an explanation within 14 calendar days.  
 

If you need assistance or have questions, please email info@idahocprplus.com or call (208) 614-2258
 

Required fields are marked with *

Please choose the class you wish to attend

Your Contact Information:

Citizenship:

Are you a United States Citizen?
Are You a Permanent Resident?

Additional Information:

Gender
Will you be 18 years of age on or before the first day of class?
Do you have a valid driver’s license?
Have you ever been convicted of a misdemeanor or felony? (Understand that the Idaho Bureau of Emergency Medical Services will require a criminal history and background check for state EMS license).
Do you have a current American Heart Association (AHA) Basic Life Support (BLS) Provider card? (If no, this will be required within the first 2 weeks of class).
Do you feel as though you are in moderate to good physical shape for the physical demands of practicing EMT skills?

Education:

What is your level of education?
Have you ever taken an EMT course before?

Sponsorship Information:

Are you being sponsored by an organization?
Who should we contact for billing purposes (if yes to the above):

Understanding of Course Hours and Time Commitment

Do you understand that this is a comprehensive course that involves 112 hours of in-classroom attendance and an additional 8 to 12 hours of an off-campus clinical rotation? Furthermore, do you understand that you may need to dedicate a minimum of an additional 1 hour of “out of classroom” study time per 1 hour of in-classroom hours?

Understanding:

I signify that the information given is, to the best of my knowledge, accurate and correct. Permission is hereby given to Idaho CPR Plus to investigate all pertinent information regarding my application. If accepted, I agree to inform the school of any changes to the information I have provided on the application prior to and after acceptance to the EMT Program and at any time during the duration of the course. Moreover, I understand that giving false information or withholding information prior to or after acceptance into the program may make me ineligible for admission or to continue my enrollment. I have read and understand the information included in the registration.

Thank you for registering, We will be in touch with you soon.