Paramedic Online Application

(Paramedic Applications are only accepted between June 1st and October 1st of each year)

Make sure to also complete the:

If you see this don't fill out this input box.

Full Name (First, Middle, Last)*

Mailing Address*

City*

State*

Zip Code*

Tech T#

Date of Birth*

Home Phone

Cell Phone

Please indicate if you are currently a student of:

Arkansas Tech University

Arkansas Tech University-Ozark Campus

Not Applicable

Have you previously attended another Paramedic Program?

Yes

If you answered yes to the previous question, where?

Please indicate the location of the campus you would prefer to attend. The paramedic program may be offered at more than one location. (further information will be sent)

Ozark

Fort Smith

If you are not currently a Tech student please remember to complete an application for admissions and send all transcripts from previous schools attended as well as proof of two MMR immunizations to the Office of Student Services, 1700 Helberg Lane, Ozark, AR 72949). School application must be completed before submitting this application. I certify that the above information is accurate and complete to the best of my knowledge. I understand that falsifying information on any of the requested forms may be cause for immediate dismissal from the Paramedic/EMS program. *Name (acting as signature)

Date (mm/dd/yyyy)*