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PRE-REQUISITES TO THE PARAMEDIC PROGRAM • Pre-Requisites must be completed PRIOR to Paramedic Course Enrollment. Requirements & Cost are SUBJECT TO CHANGE at any time. Courses are NON-REFUNDABLE. Submission of your completed enrollment packet will constitute your INTENT to enroll. You will NOT be officially enrolled until all pre-requisites have been met and passed with an 80% minimum passing score per course. Coursework must be completed 1 month prior to Paramedic Course start date. If a student is unable to complete within the deadline, a 1 week extension can be additionally purchased at the rate of $50.00 per week up to a maximum of 2 weeks in total. If the pre-requisite courses are not completed by the end of the purchased extension, the student will be dropped from the enrolled course and moved to the next available course. Same terms will apply if moved to a later course date. Credit may be granted for courses taken elsewhere within a 5 year period, PENDING sealed official transcript review. For the course to be considered as credit earned, the course work must be equivalent to the course pre-requisite. The course would need to have been passed with a minimum 2.5 cumulative course GPA. Books will be purchased by the student at an additional cost online. Books can be purchased through the Guardian College website, www.guardiancollege.com. Click on PRODUCTS & MERCHANDISE and you will be directed to the ELSEVIER portal to purchase your required books for completion of your coursework. Please allow a processing timeframe to receive your books upon processing by the book distributor. • • • • PRE-REQUISITE COURSES COURSE COST: (Cost subject to change at any time and are NON-REFUNDABLE) • Anatomy & Physiology $1400 • ECG Made Easy $1050 • Medical Terminology $ 350 TOTAL $2800 PAYMENT OPTIONS: _____ I will be paying $2800 today to enroll in Anatomy & Physiology, ECG Made Easy & Medical Terminology. _____ I will be paying $1400 today to enroll in Anatomy & Physiology only. _____ I will be paying $1050 today to enroll in ECG Made Easy only. _____ I will be paying $350 today to enroll in Medical Terminology only. I, the undersigned, acknowledge that I have read and accept the conditions of the prerequisites. I understand that until all my pre-requisite coursework is completed with a passing score and that my completed Paramedic Enrollment Packet with all required documents is received by the EMT Education Coordinator; that it is my I TE T to enroll and that no seat will be guaranteed to me in the course, pending course availability, until all is complete and received in its entirety. Student Signature Date Prospective Student: Thank you for your interest in Guardian College! We are pleased with your inquiry of enrolling in the EMT Paramedic Course. Paramedics are trained in all aspects of BLS and ALS procedures relevant to prehospital emergency care. The role of a Paramedic includes the ability to recognize a medical emergency, assess the situation, manage emergency care and extricate the patient. ACLS and PALS are included in the program. To get started with this exciting career, please complete this Enrollment Packet in its entirety with all of the required documents listed below in the checklist and include your course deposit. REQUIRED DOCUMENTS Your application will not be complete & considered officially enrolled until all documentation has been received by our EMT Education Coordinator. ____Copy of National Registry EMT-Basic Card or State Card ____Copy of Healthcare Provider CPR Card (must state Healthcare Provider on the card) ____Copy of Drivers License ____Copy of Health Insurance Card ____Copy of Sealed Official High School/College Transcript or GED ____Completed Physician Physical Form ____Official Immunization Records (Hep B series or Declination Form, MMR Series, TB test results, when applicable - Current Seasonal Flu Shot) ____Consumer Authorization Background Check Form Students are responsible for their own medical expenses during their training, including expenses due to illness, accident, or injury occurring while completing clinical contacts and ambulance ride-alongs. Guardian College requires that all students enrolled in career training programs possess medical insurance during the entire term for which they are enrolled. If you do not have health insurance, please contact a local health insurance provider. I welcome the opportunity to meet with you in person to discuss your enrollment needs. Please feel free to contact me by email at kelly@guardiancollege.com or by phone at 208-321-4744, x104. Sincerely, Kelly Combs EMT Education Coordinator Enrollment Agreement EMT Paramedic Instructions: Read, initial each page, sign, and date the bottom of page 5. Include attachments as indicated. The Enrollment Agreement is considered a contract between the student and Guardian College LLC. A fully signed copy will be provided to the student when the application is accepted and initial fees are paid. Date of Application: Course Date: Month_________________ Year _______ Fast-Track OR Evening Name (last, first, MI) Email Address City, State, ZIP Birth date (MMDDYY) Phone numbers: home cell work Social Security Number Emergency Contact Name Phone Relationship to you If you are receiving Agency funding from an employer or Contact person government agency, please list Phone number name of program, contact person and phone How did you hear about our programs? NOTE: Agencies may require proof of student progress to provide funding. What is your career goal for this program? What is your ultimate career goal? GUARDIAN COLLEGE 2150 E Fairview Ave, Suite 100 Meridian, Idaho 83642 (208) 321-4744 Fax (208) 321-4745 kelly@guardiancollege.com 3 Program Costs & Required Documents Tuition: $50 $20 $50 $6200 $6320 Application Fee HOBET Test Background Check EMT Paramedic Course TOTAL Payment Options (Initial by your selection): ____ I will be paying the $6320 in full. ____ Fast-Track EMT-Paramedic Program: I will be paying $620 today, ($500 deposit, $50 application fee + $50 background check + $20 HOBET fee) & will make payments for the remaining balance as follows: *$3000 due the first day of class *$1350 due one month from the first day of class *$1350 due two months from the first day of class ____ Long EMT-Paramedic Program: I will be paying $620 today, ($500 deposit, $50 application fee + $50 background check + $20 HOBET fee) & will make payments for the remaining balance as follows: *$475.00 x 12 months - due on the 25th of every month ____ I am attaching proof that I am approved for funding through an employer or government agency. ***Application Fee, Books & Workbooks are non –refundable and not accepted for return ***Failure to make a scheduled payment will result in immediate removal from the course ***National Registry fees are NOT included in the paramedic course Attached is my check, cashier's check, or money order for $ Please charge $ VISA Card Number: MasterCard to my credit card. AMEX Discover Expiration Date (MM/YY): CVC Code: _______________ Cardholder Name as it appears on card: (print):_______________________________________ Cardholder's Signature: _________________________________________________________ _______Please auto bill my account on all scheduled payment dates above. (initial) I authorize Guardian College LLC to photograph me and acknowledge that all photographs become the property of Guardian College LLC. I give permission for my likeness to be used in promotional materials and electronic media. ________________________________ Student Signature _____I am enrolling in the EMT Paramedic for personal enrichment rather than job training. GUARDIAN COLLEGE 2150 E Fairview Ave, Suite 100 Meridian, Idaho 83642 (208) 321-4744 Fax (208) 321-4745 kelly@guardiancollege.com 4 Program Details 1. The length of the EMT Paramedic program is 1525 hours, including AHA Basic Life Support for Healthcare Providers, EMT Basic certification ACLS and PALS certification. 2. A Certificate of Completion is awarded after successful completion and full payment of the program. 3. Tuition for the EMT Paramedic Program is $6200. Application fee is $50. Background check is $50. HOBET Exam fee is $20. Course Cost and Requirements are SUBJECT TO CHANGE at any time and are NON-REFUNDABLE. 4. Payment is due as agreed per the payment option initialed. Guardian College accepts major credit cards, personal checks, money orders, or third party payments. Failure to make a scheduled payment will result in immediate removal from the course. 5. Books will be purchased by the student at an additional cost online. Books can be purchased through the Guardian College website, www.guardiancollege.com. Click on PRODUCTS & MERCHANDISE and you will be directed to the ELSEVIER portal to purchase your required books for completion of your coursework. Please allow a processing timeframe to receive your books upon processing by the book distributor. 6. Pre-requisite courses are NON-REFUNDABLE and must be completed 1 month prior to the course start date. If a student is unable to complete within the deadline, a 1 week extension can be additionally purchased at the rate of $50.00 per week up to a maximum of 2 weeks in total. If the online courses are not completed by the end of the purchased extension, the student will be dropped from the enrolled course and moved to the next available course. Same terms will apply if moved to a later course date. 7. The Idaho EMS Bureau requires that enrollees in the Paramedic course have an EMT-Basic National Registry Card that is current. A current State card is also acceptable. 8. Medical insurance is required for each student throughout the program. A valid driver's license is required for all applicants except those who enroll for personal enrichment. 9. Applicants must be high school graduates or have obtained a GED certificate, and must be at least 18 years of age by the last day of the EMT-Basic class. Applicants must be US citizens or legal residents for employment upon graduation. Official Transcript or GED is required. 10. Applicants must have certification from a licensed physician that they are able to meet the physical requirements of the job (lifting, carrying, etc.) 11. Students are responsible for their own transportation to the training center and to clinical facilities for patient contacts, as well as appropriate clothing for clinical contacts. 12. Students are subject to dismissal for the following: Failure to maintain an 80% average in each class, Failure to complete clinical contacts, Failure to meet attendance requirements, Violation of code of conduct, non-payment. Termination date is defined as when the student is notified in writing by hand delivery or mail. 13. Code of conduct: Professional mannerism is required on campus grounds and at clinical sites. Violation of the rules of conduct will result in immediate dismissal from the campus and/or the clinical site. The rules include but not limited to: Rude and improper behavior, sexual explicit actions or language, negative remarks towards other students, instructors or patients at clinical sites. 14. Guardian College does NOT guarantee employment for its graduates. Guardian College provides student services that assist with obtaining employment, including posting job openings. GUARDIAN COLLEGE 2150 E Fairview Ave, Suite 100 Meridian, Idaho 83642 (208) 321-4744 Fax (208) 321-4745 kelly@guardiancollege.com 5 15. Students may voluntarily withdraw from the program in writing by delivering a letter to the administrative staff by hand or by mail. 16. Guardian College is a drug-free institution. It reserves the right to drug test any student at any time at his or her expense, with or without cause. Students who refuse to comply with a drug test request, or who test positive for drugs or alcohol during class time, are subject to immediate dismissal from the program. 17. It is the responsibility of the student to determine that they have the physical, mental, and emotional ability to safely participate in the program and be employed as an EMT Paramedic. REFUND POLICY • Applicants/students may cancel their enrollment within 72 hours after midnight of the day in which the completed enrollment is signed and receive a full refund of all money paid to the school. After the 72 hours applicant/student will receive a minimum of seven days in which to cancel their enrollment agreement and receive a full refund less the $50 application fee & $50 background check. For a student who wishes to withdraw after the first day of class, the following refunds will apply: One half (50%) of tuition will be refunded if the withdrawal is received during the first quarter of the program One fourth (25%) of tuition will be refunded if the withdrawal is received after the first quarter but before the first half of the program is completed. No refund will be made to the student after the first half of the course is completed. Students who are unable to complete the program due to circumstances beyond their control, such as serious illness, accident, or death in the family may request in writing a leave of absence. Students may join the next scheduled class or may request consideration of a tuition adjustment. Any monies due to the student shall be refunded within 60 days from the termination date. The termination date is defined as the last day the student was in attendance plus the number of missed class days that total 6 absences. Calculation of refund will be based on the last date of attendance. • • • • • • I, the undersigned, have received a copy, read, and accept the conditions of this enrollment agreement. I agree to abide by the code of conduct outlined in the Course Catalog. Student Signature Date Parent Signature required if applicant is not 18 on the first day of class. Date GUARDIAN COLLEGE 2150 E Fairview Ave, Suite 100 Meridian, Idaho 83642 (208) 321-4744 Fax (208) 321-4745 kelly@guardiancollege.com 6 A licensed medical doctor (MD or DO) must verify that you are able to perform the requirements of employment as an emergency medical technician. You must include official documentation of immunization records. The applicant named to the right is applying for enrollment in our EMT-Basic Program. Please verify that the applicant is able to perform the listed duties and has the listed immunizations and sign below. Dear Physician: Applicant Name Date of Examination Required Duties Lift and carry up to 75 lbs. Operate equipment and vehicles safely Work in limited light Communicate effectively with others orally and in writing See and hear (with correction, if needed) in order to ensure the safely of him/herself and others Perform work activities involving combinations of walking, kneeling, bending, pushing, pulling, lifting, carrying, and standing Perform work activities under stress in all types of weather, including extreme heat and cold Immunization status Please submit official documentation. Ex: childhood immunization records, public health immunization records. If you do not have an official copy of these records, please submit proof of titer test. You can contact Central District Health to get titer tests: 375-5211 1) MMR Dose #1 2) MMR Dose #2 3) Hepatitis B Dose #1 (or declination form) 4) Hepatitis B Dose #2 (or declination form) 5) Hepatitis B Dose #3 (or declination form) 6) TB skin test (record result in millimeters) ***must be current within 1 year from clinical start date 7) Seasonal Flu Shot (when applicable) In my professional opinion, this applicant can perform the above listed duties. Physician Signature GUARDIAN COLLEGE 2150 E Fairview Ave, Suite 100 Meridian, Idaho 83642 (208) 321-4744 Fax (208) 321-4745 kelly@guardiancollege.com 7 REFUSAL OF HEPATITIS B VACCINATION This is to certify that I,______________________________, am eligible for the Hepatitis B vaccine. I have been provided information. I also understand that due to my occupational exposure to blood or potentially infectious materials, I may be at risk of acquiring Hepatitis B (HBV) infection. However, I decline Hepatitis B vaccination at this time. I understand that by declining this vaccination, I continue to be at risk of acquiring Hepatitis B, a serious disease. If in the future if I continue to have occupational exposure to blood or other potentially infectious materials and I want to be vaccinated with the Hepatitis B vaccine, I may receive the vaccination series. I hereby refuse vaccination at this time. _____________________ Signature of Student _________________ Date GUARDIAN COLLEGE 2150 E Fairview Ave, Suite 100 Meridian, Idaho 83642 (208) 321-4744 Fax (208) 321-4745 kelly@guardiancollege.com 8 CONSUMER AUTHORIZATION ($50 Background Check Fee) I. I understand that an investigative report may be generated on me that may include information as to my character, general reputation, personal characteristics, or mode of living; work habits, performance or experience, along with reasons for termination of past employment/professional license or credentials; financial/credit history; or criminal/civil/driving record history. I understand that General Information Services, Inc. (GIS), on behalf of Guardian College or one of its affiliates may be requesting information from public and private sources about any of the information noted earlier in this paragraph in connection with Guardian College or one of its affiliates’ consideration of me for employment, promotion or position re-assignment or contract now, or at any time during my tenure with Guardian College or one of its affiliates, and give my full consent for this information to be obtained. II. IF APPLICABLE, medical and worker’s compensation information will only be requested in compliance with the Federal Americans with Disabilities Act (ADA) and/or any other applicable state laws. III. According to the Fair Credit Reporting Act (FCRA, Public Law 91-508, Title VI), I am entitled to know if the considerations for which I am applying are denied because of information obtained from a consumer reporting agency. If so, I will be notified and be given the name of the agency providing that report. IV. I acknowledge that a telephonic facsimile (FAX) or photographic copy of this release shall be as valid as the original. This release is valid for most federal, state and county agencies. V. I hereby authorize Guardian College LLC to obtain and distribute the information in my background check as they see fit. V. I understand that I may obtain a copy of the report ordered, & indicate my desire to do so by INITIALING this box . VI. I hereby authorize, without reservation, any financial institution, law enforcement agency, information service bureau, school, employer or insurance company contacted by GIS to furnish the information described in Section I. VII. Upon proper identification, you have the right to make a request to GIS, within a reasonable period of time, as to the nature and substance of all information in its files on you at the time of your request, including the sources of information and the recipients of any reports on you that GIS has previously furnished. Communications with GIS should be directed to PO Box 353, Chapin SC 29036 or (866) 265-4917. CANDIDATE COMPLETE THE FOLLOWING: ___________ Signature ___________ Please print full name __ __ Today’s Date The following information is required by law enforcement agencies and other entities for positive identification purposes when checking public records. It is confidential and will not be used for any other purposes. Month, Day and Year of Birth Home Address Driver’s License Number and State Have you ever been convicted of a crime? __ No details of conviction. __ Yes ______ Social Security Number City State Zip Name as it appears on License If yes, please provide city and state of conviction and FAIR CREDIT REPORTING ACT NOTICE: In accordance with the Fair Credit Reporting Act (FCRA, Public Law 91-508, Title VI), this information may only be used to verify a statement(s) made by an individual in connection with legitimate business needs. The depth of information available varies from state to state . Status of updates are available on request. Although every effort has been made to assure accuracy, General Information Services, Inc. cannot act as guarantor of information accuracy or completeness. Final verification of an individual’s identity and proper use of report contents are the user's responsibility. General Information Services, Inc.’s policy requires purchasers of these reports to have signed a Service Agreement. This assures General Information Services, Inc. that users are familiar with and will abide by their obligations, as stated in the FCRA, to the individuals named in these reports. If information contained in this report is responsible for the suspension or termination of an employee or the application process, have the Candidate/employee contact General Information Services, Inc. GUARDIAN COLLEGE 2150 E Fairview Ave, Suite 100 Meridian, Idaho 83642 (208) 321-4744 Fax (208) 321-4745 kelly@guardiancollege.com 9 https://www.chu.dhw.idaho.gov/Default.aspx 7/23/2009 Idaho Criminal History Unit What is a disqualifying offense? A disqualifying offense is a specific offense which precludes an applicant from providing services or receiving a background check clearance. If an applicant is found to have a disqualifying crime listed below, they will be issued an unconditional denial and not allowed to provide services or receive licensure or certification. An applicant has thirty (30) days to challenge the Department’s Unconditional Denial by submitting in writing and providing court records or other information which demonstrates the Department’s unconditional denial is incorrect. These documents must be filed with Criminal History Unit, 3268 Elder Street, Boise ID 83705. An Unconditional Denial will be issued for the following crimes: • Abuse, neglect or exploitation of a vulnerable adult, as defined by Section 18-1505, Idaho Code • Aggravated, first degree and second-degree arson, as defined by Sections 18-801 through 18-805, Idaho Code • Crimes against nature, as defined by Section 18-6605, Idaho Code • Forcible sexual penetration by use of a foreign object, as defined by Section 18-6608, Idaho Code • Incest, as defined by Section 18-6602, Idaho Code • Injury to a child, felony or misdemeanor, as defined by Section 18-1501, Idaho Code • Kidnapping, as defined by Sections 18-4501 through 18-4503, Idaho Code • Lewd conduct with a minor, as defined by Section 18-1508, Idaho Code • Mayhem, as defined by Section 18-5001, Idaho Code • Murder in any degree, voluntary manslaughter, assault or battery with intent to commit a serious felony, as defined by Sections 18-4001, 18-4003, 18-4006, and 18-4015, Idaho Code • Poisoning, as defined by Sections 18-4014 and 18-5501, Idaho Code • Possession of sexually exploitative material, as defined by Section 18-1507A, Idaho Code • Rape, as defined by Section 18-6101, Idaho Code • Robbery, as defined by Section 18-6501, Idaho Code • Felony stalking, as defined by Section 18-7905, Idaho Code • Sale or barter of a child, as defined by Section 18-1511, Idaho Code • Sexual abuse or exploitation of a child, as defined by Sections 18-1506 and 18-1507, Idaho Code • Video Voyeurism, as defined by Section 18-6609, IdahoCode • Enticing of Children, as defined by Section 18-1509 and 18-1509A, Idaho Code • Inducing individuals under eighteen years of age into prostitution or to Patronize a prostitute as defined by Sections 18-5609 and 18-5611, Idaho Code • Any felony punishable by death or life imprisonment • Attempt, conspiracy, accessory after the fact or aiding and abetting as defined by Sections 18-205, 18-306, 18-1701, and 19-1430, Idaho Code to commit any of the disqualifying designated crimes. An unconditional denial will be issued for any of the following disqualifying offenses for five years from the date of the conviction or withheld judgment. • Aggravated Assault as defined by Section 18-905, Idaho Code • Aggravated Battery as defined by Section 18-907 (1), Idaho Code • Any felony involving a controlled substance • Arson in the third degree as defined by Section 18-804, Idaho Code • Attempted Strangulation, as defined by Section 18-923, Idaho Code • Burglary as defined by Section 18-1401, Idaho Code • Felony Computer Crimes as defined by Section 18-2202, Idaho Code • Felony Domestic Violence as defined by Section 18—918, Idaho Code • Felony Lottery Crimes as defined in Section 67-7448, Idaho Code • Felony Theft as defined by Section 18-2403, Idaho Code • Forgery and counterfeiting as defined by Section 18-3601 through 18-3620, Idaho Code • Forgery of and fraudulent use of a financial transaction card as defined by Sections 18-3123 and 18-3124, Idaho Code • Grand theft as defined by Section 18-2407(1), Idaho Code • Identity Theft as defined in Section 18-3126, Idaho Code • Insurance fraud as defined by Sections 41-293 and 41-294, Idaho Code • Public assistance fraud as defined by Sections 56-227 and 56-227A, Idaho Code • Attempt, conspiracy, accessory after the fact or aiding and abdetting as defined by Sections 18-205, 18-306, 18-1701 and 19-1430 Idaho Code, to commit any of the disqualifying five(5) year crimes GUARDIAN COLLEGE 2150 E Fairview Ave, Suite 100 Meridian, Idaho 83642 (208) 321-4744 Fax (208) 321-4745 kelly@guardiancollege.com 10
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