ST. ANTHONY HOSPITAL* INSTITUTE OF EMERGENCY MEDICAL TRAINING

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1 ST. ANTHONY HOSPITAL* INSTITUTE OF EMERGENCY MEDICAL TRAINING PARAMEDIC ACADEMY Cycle #98 Application Deadline Wednesday April 22, 2015 at 5pm. Application Testing Tuesday April 28 th or Wednesday April 29 th All information included on this form is subject to change COURSE COMPLETION/LENGTH: COURSE CLASS SIZE: 12 Minimum The course is divided into three sections: Section I Beginning of Didactic Hours to Midpoint Section II Midpoint to Final Examination hours Section III Hospital Clinical Rotations hours Field Internship 500 hours Total Course 1, hours (without A&P)** *Note: Anatomy & Physiology is included in the St. Anthony Paramedic Program. Those applicants who have successfully completed A&P (BIO 201& 202) will not be required to attend class on the days A&P are taught within the Paramedic Academy. **Additional classroom hours for A&P will be added to total course hours (for those students requiring it) COST/FEES: (Subject to change) $50.00 Application processing & testing fee to be paid online with application (non-refundable) $ Tuition $ Technology Fee $95.00 Lab Fee $6, Total Fees (Payable to St. Anthony PreHospital Services) Additional Costs Not Included in the Tuition Required Textbooks w/ Learning Management System (LMS): approximately $650-$800 Uniforms approximate cost: $200 Background Check: approximate cost $50 Student Health Screening: cost varies National Registry Paramedic Written Examination: $ GENERAL INFORMATION The Paramedic Academy is presented by St. Anthony Hospital PreHospital Services. The Paramedic Program Director is Tracy Lynn Collins, RN, BSN, NRP, Gina Soriya, MD, FACEP is the Medical Director, and Marilyn Bourn, RN, MS, NRP is the Clinical Coordinator. Principal faculty for the Paramedic Academy includes emergency physicians, registered nurses and paramedics. Adjunct faculty is comprised of professionals from other inter-related fields. The Paramedic Academy is accredited by the Commission on Accreditation of Allied Health Education Programs in cooperation with the Joint Review Committee on Educational Programs for EMT-Paramedic. The Colorado Community College and Occupational Education Systems also recognize Paramedic Academy for 49 college semester credits. The course content prepares the student for advanced emergency medical care under the direct radio/telephone communication of an emergency physician or within the protocols set forth by their physician advisor. Field/clinical experience is provided to our students. These clinical hours are in specialized critical care areas. Additional field experience is provided through affiliated EMS agencies. Successful course completion includes certification in Advanced Cardiac Life Support, Pediatric Advanced Life Support, Pediatric Education for Pre-Hospital Providers and International Trauma Life Support. Graduates of the Paramedic Academy are eligible to apply for certification with the National Registry of EMT-Paramedics and the State of Colorado. The course is approved for Workforce Investment Act and Veteran Benefits. Other government and private scholarship funds may be available. For more information, contact Jami Cavos at or

2 STUDENT ELIGIBILITY/CHECK SHEET Applications must be submitted to the St. Anthony s PreHospital Office by Wednesday, April 22, 2015 at 5pm (deadline for applying). Incomplete applications, missing any documentation, essay questions, or application fee, will not be processed or considered for acceptance into the program. We will also NOT accept scanned/ ed or faxed application or support documents. Prerequisites: Documentation of the following MUST be submitted, as well as your completed application, by the application deadline in order to be considered for the Paramedic Academy: Current EMT-Basic, AEMT or EMT-Intermediate certification Current Healthcare Provider - CPR Certification Copy of high school diploma, GED, unofficial college transcript or college diploma Proof of 10 th grade reading level or above. May be any of the following: Unofficial College Transcript or college diploma OR College Placement Testing (i.e. Accuplacer, Compass, ACT/SAT Scores) OR Workforce Development assessment testing. Note: high school diploma is NOT accepted as proof. IVApproval course completion certification (if applicant is an EMT-Basic) Two recommendation letters. All letters must be original, on letterhead and signed. They may be mailed directly to the PreHospital Office or included with your application if they are in a sealed company envelope. s will not be accepted. Examples include but are not limited to: Required Personal letters of reference Optional Primary EMS Agency Current Employer (non-ems) Primary Agency Physician Advisor Non-EMS work related letters *Note: Anatomy & Physiology (BIO 201 & 202) is not a requirement for admission to the program. Anatomy & Physiology /BIO 106 (College Level) is included in the program at no additional cost. Applicants meeting the eligibility requirements Once completed applications are submitted, applicants will be scheduled for the Knowledge Assessment Exam. Tests will be given on Tuesday April 28 th or Wednesday April 29 th 0900 hours at the EMS Education Building, 34 Van Gordon Street, Lakewood, Colorado There is no practical skills testing included on this exam. Only applicants passing the entrance exam with a score of 80% or higher will be considered for acceptance into the Paramedic Program. Please be aware that class size is limited. Passing with an 80% or better is not a guarantee acceptance. Applicants with a St. Anthony's affiliated Agency (who have met all admission requirements) will have priority. The EMS Office will notify successful and unsuccessful applicants by and /or regular mail. Please do not telephone for results.

3 Upon acceptance into the Paramedic Academy, and no later than one week prior to the start of class, students must provide the following items to the PreHospital Services Office or may forfeit their seat. Completed and signed St, Anthony Health form of verification of good health including copies of: Measles, Mumps and Rubella, Chicken Pox record or immunity titer Hepatitis B vaccination series started or immunity titer Seasonal flu vaccination Tuberculosis Testing (PPD) current within the last year (NOTE: Student MUST maintain current (within a year) TB testing throughout the duration of the program. Centura Drug Screening (because results time may vary, at a minimum, documentation of in progress will be accepted until the final report is received.) PreCheck, Inc background investigation with national healthcare provider clearance approval verification. Result time may vary, so at a minimum, documentation of in progress will be accepted until the final report is received. CBI/FBI fingerprint-based criminal history record check is NOT acceptable as substitute. Minimum of $2,000 of the tuition paid prior to the 1 st day of class and/or documentation of tuition guarantee (i.e. agency sponsorships, VA, Workforce or student loan approval, etc). Students leaving the Paramedic Academy early will be eligible for a prorated refund based upon length of attendance. Mail completed applications with all required documentation to: St. Anthony PreHospital Services 34 Van Gordon Street, Suite 200 Lakewood, Colorado APPLICATIONS MISSING ANY DOCUMENTATION or INCOMPLETE APPLICATIONS (INCLUDING ESSAY QUESTIONS) WILL BE RETURNED. APPLICATION DEADLINE WEDNESDAY APRIL 22, 2015

4 ST. ANTHONY HOSPITALS - PARAMEDIC ACADEMY PARAMEDIC SCHOOL APPLICATION NOTE: Check for $50 to St. Anthony Hospital (processing & testing fees) must accompany this application, or your application will not be considered and will be returned. These fees are non-refundable and non-transferable. PLEASE PRINT Name (last) (first) (middle) Address city state zip code home phone work phone date of birth social security # Primary agency affiliation years with agency Secondary agency affiliation years with agency PHOTOCOPIES OF ALL DIPLOMAS, CERTIFICATES and COLLEGE TRANSCRIPTS MUST ACCOMPANY THIS APPLICATION CERTIFICATIONS CPR Healthcare Provider Certification issued by expiration date EMT Certification issued by the state of expiration date AEMT Certificate issued by the state of expiration date EMT-Intermediate Certification issued by the state of expiration date National Registry * Level number expiration date EDUCATION Initial EMT school Completion year Initial AEMT school Completion year Initial EMT-Intermediate school Completion year IV Approval Course school Completion year EKG Course school Completion year Anatomy & Physiology I College Completion year Anatomy & Physiology II College Completion year High School diploma GED Completion year College degree in / completed yes no Years of attendance College degree in / completed yes no Years of attendance Additional Education (list)

5 PAID WORK EXPERIENCE (list your last 3 jobs starting with current employer) 1 company city/state Phone dates employed to 2 to 3 to EMS/HEALTHCARE VOLUNTEER WORK EXPERIENCE 1 Agency city/state Phone dates worked to 2 to 3 to List two friends or relatives who may be contacted in an emergency. 1 name phone relationship 2 name phone relationship Have you ever been convicted of a felony? yes no If yes, please explain (attach page if needed) I have previously attended courses at St. Anthony yes no ESSAY QUESTIONS Please answer the following questions. Each response MUST be typed, on separate sheets, and returned with your application. 1. Describe an incident in which you assisted another person to resolve a difficult situation. 2. How do you see your past experiences and knowledge contributing to a career in Paramedicine and Emergency Medical Services? 3. Describe your short and long-range professional goals. STUDENT AGREEMENT: I understand that should I fail to comply with any of the specified requirements of this application, or if I have made any misrepresentations in the information contained herein, that I could be dismissed or my certificate of completion withheld, without refund of tuition and/or fees paid. I further understand that acceptance into any course is left to the discretion of the Institute and available space. I also understand that submission of an application does not guarantee acceptance into the Paramedic Academy. In addition, I understand that I am responsible for payment of all fees and tuition IN FULL, the first day of class, unless other arrangements for payment have been made in advance. I further understand that I am responsible for providing my class uniform, books, and other personal items needed for successful course completion. By signing below, I authorize the St. Anthony Institute of Emergency Medical Training to conduct appropriate background, employment and credit investigations as needed to process this application. applicant's signature date print name This Institute does not discriminate on the basis of race, color, national origin, ancestry, martial status, sex, sexual orientation, religion, age, disability, or veteran s status. We reserve the right to cancel any program that does not meet the minimum number for student enrollment.

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