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1. Go! to! http://www.eastms.edu/! to! submit! an! online! (East Mississippi Community College)

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U.S.A. forms for East Mississippi Community College

BROWSE EAST MISSISSIPPI COMMUNITY COLLEGE FORMS

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Admissions!Admissions!
THE!APPLICATION!PROCESS!CHECKLIST:!
1. Go! to! http://www.eastms.edu/!
to! submit! an! online! application! for! admission! to! East! Mississippi
Community! College.! !Acceptance! to! East! Mississippi! Community! College! does! not! guarantee
acceptance! to! the! EMS! program.! !Letters! of! pending! acceptance! will! come! from! t
he! Director! of
Emergency!Medical!Services!Technology.
2. Fill! out! an! application! for! the! Emergency! Medical! Services! Technology! Program! (included! in
this! packet).! ! This! application! should! be! returned! via email at alliedhealth@eastms.edu.
Make!sure!to!include!any!documentation!needed!for!extra!points!on!the!scoring!sheet.
3.
Request!transcripts! to! be!sent!to!EMCC!from!all!other! educational! institutions!you!have! attended!–!this
includes! high! school.!!(Transfer! Request! Form! included! in! this!
packet)! Make! sure! you! request
transcripts!from!all!schools!attended.
4.
Make! sure!your! ACT! scores! (minimum! composite!score! 16)! are! on! file! in! the! admissions! office! or
schedule!and!take!your!ACT!
before!the!published!deadline.
5. After! the! deadline! you! will! be! notified! if! you! have! been! selected! for! pending!
admission.!!If! you
accept! a! slot! in! the! program,! you! will! be! sent! an! information! packet! to! complete.! It! is! your
responsibility!to! be!sure!that!all!of! your! paperwork!is! on! file!prior!to!the!deadline.!! Remember,!just
because!you! requested!a!document!to! be!sent!to! EMCC!does!not! mean!that!it! was!actually!sent!or
received.
Admissions!Admissions!
Emergency!Medical!Services! Technology! Program!
East Mississippi Community College
P.O. Box 100
Mayhew, MS 39753
or via email at alliedhealth@eastms.edu
EMERGENCY!MEDICAL!SERVICES!TECHNOLOGY!APPLICATION!
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Personal!Information!
Name:______________________________________________________________________!
Last! ! ! First! ! ! Middle!! ! Maiden!
Social!Security!Number:_________________________________________________________!
Address:______________________________________________________________________!
!!!!!Street!! Apt.!#! ! P.O.!Box!! City! ! State! !!!!!!!!Zip!Code!
Email!address:_________________________________________________________________!
Telephone!#s:!Home____________________________Cell_____________________________!
EMERGENCY!CONTACT!INFORMATION!
Name___________________!Relationship________________!Contact!number______________!
Admissions!Admissions!
Name!and!location!of!institution!
Dates!attended!
Major!or!area!of!Study!
Degree!Awarded!
* An!official!transcript!from!all!educational!institutions!attended!and/or!GED!results!must!be
mailed!to: Admissions!
East!Mississippi!Community!College!
P.O.!Box!100!
Mayhew,!Mississippi!39753!
Name!of!facility!previously!or!currently!
employed!as!a!healthcare!worker!
Credentials/Licensure
!
High!School! Attended:!_________________________
!
___________Graduation!Date:_______________!
Schoo
!
!
l!Address,! City,!State:!____________________________________! GED!Test:!Yes__! No__!
List!al
!
l!colleges!attended!(including!EMCC):!
Admissions!Admissions!
• Have!you!ever!been!convicted! of,! pled! no! contest! to,! or! are!charges! pending! against! you! for
a!felony!or!misdemeanor!in!any!state/jurisdiction?!YES! NO
• I!state!that!the!foregoing!statements!in!this!application!are!true!and!accurate.
• I! am! aware! that! omission! of! transcripts! from! other! schools! attended,! or
any! false, misleading,! or! incomplete! statements! made! on! this! application! could! be
grounds! for! non-admission! to,! or! later! dismissal! from,! the! Emergency
Medical! Services! Technology Program.
Signed____________________ _ _ _ ________________Date_________________!
Please submit completed application via email to
alliedhealth@eastms.edu
Admissions!Admissions!
DMM$6$01(;-0'%6-$4.()*+,*%.(2&-#(
Please!send!an!official!copy!of!my!transcript!to!the!address!checked!below.!
If!you!p la n !to!atten d !the!Scooba!Campus,!Meridian!Navy!Base!Extension,!or!Macon!Extension!use!this!address:!
□East!Mississippi!Community!College!●Office!of!Admissions!●P.O.!Box!158!●Scooba,!MS 39358
If!you!pla n!to!atte n d !t h e !Golden!Triangle!Campus!or!Columbus!Air!Base!Extension!use!this!address:!
□ East!Mississippi!Community!College!●Office!of!Admissions!●P.O.!Box!100!●Mayhew,!MS!39753
```````````````````````````````( ```````````````````````````````!
Last!School/College!Attended! Date!of!Attendance!or!Graduation!
Name`````````````````````````````````````````````````````````````````````````!
(Please!use!n ame!you!w e re!en ro lled !un d er) !
Student’s!Current! Address```````````````````````````````` ````````````````` `````````(
!(Numb er!o r!Stre et)! !!!!!(C ity )! !(State)! (Zip)!
Student’s!Email!Address```````````````````````````` ````````` ``````` ```````` ```````(
Date!of! Birth! ```````````````Social! Security! Number! ```(```( ```( L( ```( ```( L(```(```(```( ```(
Signature! _```````````````````````````````````````(((( Date!````````````````````````(
Please!send!transcript:!□ Immediately! □ After!grades!ar
e!posted ! □ After!graduation!!
Note:! On!high! school! transcript,!please! show!date! of!graduation,! ACT/! SAT!scores,! and! principal’s!
signature.!!
*******************************************************************************!
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1. Go to http:www.eastms.edu to submit an online (East Mississippi Community College)

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Completed 26 July 2020

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