Cowley College

Emergency Medical

Emergency Medical Services

Paramedic Program Application Form

*Required Field

Personal Information

*First Name:

Middle Name:
*Last Name:
*Email Address:
*Home Phone Number:
Cell Phone Number:
*Address:
*City:
*State:
*Zip:

Educational Background

*High School:

(both fields required)

College:
Degree:

Other Education (describe):

Program Prerequisites:

If you answered "no" to any of the previous questions, please explain:

Work Experience:

Describe your work experience, particularly any experience you might have in pre-hospital care, public safety or healthcare:

Program Schedule selection:



Verify

OTHER DOCUMENTS THAT MUST BE SUBMITTED:
After submitting this application please mail or email the following documents to the EMS Program Director:

  • Two letters of reference (typically from previous employers or instructors)
  • A copy of your current EMT or AEMT certification card
  • A copy of your NIMS/ICS certifications (if applicable)
  • A copy of your unofficial college transcripts

BE SURE TO INCLUDE YOUR NAME AND CLASS APPLIED FOR WHEN SUBMITTING DOCUMENTATION.

Submit the listed documents above to:

Chris Cannon, EMS Program Director
Chris.Cannon@cowley.edu
1406 E. 8th Street
Winfield, KS 67156

620.229.5985

Official transcripts for high schools and colleges must also be sent to our registrar.