Emergency Medical Technician (EMT) Application

Emergency Medical Services

"*" indicates required fields

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First name*

Last name*

PCC email*

PCC ID number*

Education information

I have completed*

(check all that apply)

High school diploma

GED

College level coursework

List colleges attended below

If applicable, transcripts are also required as part of the placement process.

College or university

State

Dates of attendance

Unofficial transcripts

If you completed a prerequisite course (WR 115, RD 90 or MTH 20 - equivalent or higher) outside of PCC, please upload your unofficial transcripts here.

Accepted file types: pdf, jpg, jpeg, gif, png, Max. file size: 20 MB.

Please list the term you are applying for*

Term, year (Example: Fall, 2022)

EMS 105 time of day preference*

AM or PM, or accelerated (if offered)

Immunizations, BLS, background check, and drug test requirements

I understand that once I submit this application, I am required to complete the following requirements through CastleBranch prior to placement into the program. I understand that there is a cost associated with each of these requirements. Failure to complete the following steps will make my application ineligible for admissions consideration. (Please see the EMT apply page and review the advising guide for more details.)

I will perform the following tasks through the CastleBranch system:

Create a DISA Healthcare Technology (CastleBranch) account

Use the package code PO93 (letter O) to fulfill requirements

Complete and upload proof of my required immunizations

Complete and upload proof of my current American Heart Association Basic Life Support (BLS) for Providers

Schedule a background check

Schedule a drug test

I understand that failure to complete the above requirements prior to the start of my intended application term will make my application ineligible for admission consideration

Disclaimer

By electronically submitting this application, I acknowledge that PCC may be required to provide some of my student information to the Oregon Health Authority, EMS & Trauma Section, in order to process my EMT Course application. Additionally, I understand that some of my student information is necessary to be provided to NREMT and certain professional and clinical sites (hospitals, ambulance agencies, et. al.) for eligibility regarding required clinical components and national testing processes (e.g., criminal background check initiation and results, drug screen results, attendance information and, potentially, information about passing classes). I hereby give my consent to release information as needed.

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