Paramedic Program @ UMass Dartmouth - PDF by lsg16921

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									Application for the Paramedic Program - Fall 2008
University of Massachusetts Dartmouth
139   South   Main   Street,   Fall   River,   MA   02721




  Paramedic Program @ UMass Dartmouth
                Tuesday & Thursday 6-10pm
                  And Saturday 9am-4pm

                            Starts
                       September 9th 2008


       Be part of an exciting paramedic program


              Financing Available Please Inquire



Question please call Andrew DeFrias at 508-858-0266 or
              email adefrias@ifeme.com



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   Application for the Paramedic Program - Fall 2008
   University of Massachusetts Dartmouth
   139    South      Main     Street,        Fall   River,     MA    02721
Student Information:

       Name: ________________________________________ DOB: ____/____/____
       SS#: ______________________ E-mail: ________________________________
       Address: __________________________________________________________
       City/Town: _______________________________ State: ______ Zip: __________
       Home Phone: _____________________ Cell/Pager: _______________________
       Other: _______________________
       Current EMT Certification:    Basic     Intermediate     Other_________________
       State or National: _________ Cert #: _______________ Exp Date: ____________


Questions: (if you answer yes to any of these three questions please attach an explanation)
       Have you ever taken a Paramedic Program?                              Yes      No
       Has your Certification to work as a EMT ever been suspended?          Yes      No
       Have you ever been convicted of a felony?                             Yes      No


To help the staff and instructors better understand our students, please tell us why you want to be a
Paramedic and any further education you might be seeking? (Feel free to use extra room if necessary,
but no more then 100 words)




I ________________________________ attest that all information provided by me is true and
accurate to the best of my knowledge. Any attempt to offer incorrect or fraudulent information will
result in immediate withdrawal of this application, termination from the program and loss of all fees,
costs and tuition which will be subject to the refund policy.

_______________________________                                _______________
Signature                                                      Date

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   Application for the Paramedic Program - Fall 2008
   University of Massachusetts Dartmouth
   139    South     Main    Street,     Fall   River,    MA   02721
Please attach copies of Current Certification Cards below:

State EMT Certification                                 National EMT Certification (if applicable)




Health Care Provider CPR card (front)                   Health Care Provider CPR card (back)




Other EMS Certifications




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   Application for the Paramedic Program - Fall 2008
   University of Massachusetts Dartmouth
   139    South       Main     Street,      Fall    River,       MA   02721

Application Information:

   1. Submit completed application to the following address:

                                   University of Massachusetts Dartmouth
                                   Professional & Continuing Education
                                   139 South Main Street
                                   Fall River, Massachusetts, 02721-5306

   2. Take entrance exam (written exam will test English, Math & Basic EMT knowledge). The
      Program Coordinator will contact you after they receive the application to schedule the exam.

   3. The Program Coordinator will review applications and test results.

   4. If you are accepted you will receive an acceptance letter with further directions for registering
      and paying Tuition or down payment.

   5. Students can then start the process of Financial Aid if applicable.

   6. Students who are currently working in EMS will have preference


Program Costs: (Some of these costs are approximate and may change)

         1.   Paramedic Tuition (due prior to class start)            $6,500
         2.   Due on acceptance                                       $1,000
         3.   Required Course Texts:                                  $450 approximate
         4.   Clinical uniform                                        $50 minimum
         5.   Stethoscope: (if student doesn’t all ready have)        $30-$180
         6.   Exams and certification fee’s approximate:              $250
         7.   Immunizations (if needed)                               $ unknown
         8.   Liability Insurance:                                    $29-$200/year




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  Application for the Paramedic Program - Fall 2008
  University of Massachusetts Dartmouth
  139   South     Main      Street,           Fall   River,   MA   02721



Paramedic Program Requirements:

           1.   Completed Application (all incomplete application will be returned)
           2.   Must be 18 years old at start of Program
           3.   Must have High School Diploma or GED
           4.   1 year of experience working as a EMT is recommended, with preferences given to
                active EMS employment
           5.   Current EMT Basic or Higher Certification required
           6.   Current Healthcare Providers CPR Card required
           7.   All Current Certification must stay valid for the length of the program
           8.   Complete CORI check (for clinical rotations)
           9.   Current immunizations: MMR, Chicken Pox (or immunity), Hepatitis B, TB(Due
                prior to starting Clinical)
           10. Drug Screen (Due prior to starting clinical – depending on clinical site)




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