Paramedic application | Emergency Medical Services at PCC_ŷ�ޱ��app_ŷ�ޱ��-Ͷע|��

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Emergency Medical Services

Paramedic application

"*" indicates required fields

First name*

Last name*

PCC email*

PCC ID number*

I have completed*

(check all that apply)

High school diploma

GED

College level coursework

List colleges attended below

If applicable, official transcripts are also required as described in the Plan your first term steps.

College/University

State

Dates of attendance

Unofficial transcripts

If you completed a prerequisite course outside of PCC, please upload your unofficial transcripts here.
Prerequisite courses must be complete by the end of Summer term, 2023 prior to starting the program in winter term, 2024. See the full list of prerequisites.

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

Prerequisite courses
List the details for your prerequisite courses. All students are encouraged to meet with an EMS advisor prior to application to ensure prerequisite course requirements have been fulfilled. For application questions, please email ems@pcc.edu.

MTH 65: Introductory Algebra, or higher*

Completed prerequisite course number

Completed prerequisite title

Educational institution

Grade received

WR 121: English composition, or higher*

Completed prerequisite course number

Completed prerequisite title

Educational institution

Grade received

HE 295 or PE 295: Health and Fitness for Life*

Completed prerequisite course number

Completed prerequisite title

Educational institution

Grade received

Arts & Letters Elective: Any course 100 level or above*

(see AAS general education requirements)

Completed prerequisite course number

Completed prerequisite title

Educational institution

Grade received

Social Science Elective: Any course 100 level or above*

(see AAS general education requirements)

Completed prerequisite course number

Completed prerequisite title

Educational institution

Grade received

EMS 100 (or FP 101): Intro to Emergency Medical Services*

Completed prerequisite course number

Completed prerequisite title

Educational institution

Grade received

EMS 105: Emergency Medical Technician Basic �C Part I*

Completed prerequisite course number

Completed prerequisite title

Educational institution

Grade received

EMS 106: Emergency Medical Technician Basic �C Part II*

Completed prerequisite course number

Completed prerequisite title

Educational institution

Grade received

EMS 114: Emergency Response Patient Transport*

Completed prerequisite course number

Completed prerequisite title

Educational institution

Grade received

EMS 115: Crisis Intervention*

Completed prerequisite course number

Completed prerequisite title

Educational institution

Grade received

EMS 116: EMS Rescue*

Completed prerequisite course number

Completed prerequisite title

Educational institution

Grade received

MP 111: Medical Terminology*

Completed prerequisite course number

Completed prerequisite title

Educational institution

Grade received

BI 231: Human Anatomy & Physiology I*

(must be current within 7 years)

Completed prerequisite course number

Completed prerequisite title

Educational institution

Grade received

BI 232: Human Anatomy & Physiology II*

(must be current within 7 years)

Completed prerequisite course number

Completed prerequisite title

Educational institution

Grade received

BI 233: Human Anatomy & Physiology III*

(must be current within 7 years)

Completed prerequisite course number

Completed prerequisite title

Educational institution

Grade received

Required supporting documents*

Please attach the following supporting documents:

Copy of Current Oregon EMT Licensure or higher (out of state students should allow 12 weeks for reciprocity to Oregon)
Copy of Current American Heart Association (AHA) Basic Life Support (BLS) Healthcare Provider level card
If you are substituting any prerequisite courses from another college or university, include a copy of your email correspondence for approval of these courses below.

Drop files here or

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

Personal statement*

Please respond to the following prompt: What are your unique qualities and professional goals as a Paramedic? (2500 character max)

Patient Contact Experience*

List all healthcare experiences in which your responsibilities allowed for direct patient contact (e.g. nurse, EMT, aide, medical assistant, ambulance/fire service)

Employer

Supervisor's name

Contact phone number

Your position title

Months/years in position

Full-time, part-time, or volunteer?

References
Identify three individuals (not related to you) whom you have requested recommendation in support of your application.

Reference #1*

Name

Occupation

Telephone

Reference #2*

Name

Occupation

Telephone

Reference #3*

Name

Occupation

Telephone

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 Paramedic 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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