LAWRENCEVILLE I ALPHARETTA -NORTH FULTON
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I I I I
Advanced EMT Certificate
1 semester
Program Advisement Form
The program advisement form is required for admissions to the Advanced EMT Certificate. Students applying to the Advanced EMT
certificate will be accepted to the EMS Professions program and given Industry Certification credit for the EMT courses based on proof
of current EMT or EMT-Basic (with successful completion of Georgia State Office of Emergency Medical Services and Trauma
(SOEMST) EMT-B to EMT update course); or proof of successful completion of EMSP 1110, EMSP 1120, EMSP 1130, EMSP 1140,
EMSP 1150, AND EMSP 1160.
Please complete Applicant Information below:
First Name Middle Name Last Name
Address City State Zip code
Please select the Campus and Start Term for which you are applying:
LAWRENCEVILLE CAMPUS - Please select your start term & note the application deadline
Fall Semester: June 1
Prerequisite Deadline: End of Summer Term
Day classes; 2/week
Spring Semester: October 10
Prerequisite Deadline: End of Fall Term
Day classes; 2/week
Spring Semester: October 10
Prerequisite Deadline: End of Fall Term
Night classes; 3/week
Summer Semester: March 22
Prerequisite Deadline: End of Spring Term
Day classes; 4/week (Accelerated)
ALPHARETTA - NORTH FULTON CAMPUS - Please select your start term & note application deadline
Fall Semester: June 1
Prerequisite Deadline: End of Summer Term
Day classes; 2/week
Spring Semester: October 10
Prerequisite Deadline: End of Fall Term
Day classes; 2/week
Please read and initial each of the following statements:
_____ I have verified my admissions file is complete and I have been accepted to Gwinnett Technical College.
_____ I understand I must be in good academic standing at the time the program starts.
_____ I understand I must be 18 years of age at the time program starts.
_____ I understand criminal background checks and drug screens are required based on the requirements for participation in
clinical experiences.
_____ I understand I must provide proof of current EMT or EMT-Basic (with successful completion of Georgia State Office of
Emergency Medical Services and Trauma (SOEMST) EMT-B to EMT update course); or proof of successful completion of
EMSP 1110, EMSP 1120, EMSP 1130, EMSP 1140, EMSP 1150, AND EMSP 1160.
_____ I understand that students will be sent a confirmation email within one week after deadline. Students are required
to respond to the email to secure a spot in the program and register for classes.
_____ I understand that is it my responsibility to return this completed form to Kim Smith, Program Specialist; Health
Sciences, Building 200, Room 212 on the Lawrenceville Campus or by email at kimberlysmith@gwinnetttech.edu.
Student Signature: __________________________________________________________ Date: ___________________
Enrollment Advisor Signature: ________________________________________________ Date: ___________________
Student has complete and active admissions
file
Student has submitted all previous transcripts
Student is in good academic standing
Student’s Driver’s License and/or P-Card have not
expired
The Gwinnett Technical College does not discriminate on the basis of race, color, national origin, sex, age, or disability.
Lisa Richardson, Section 504/ADA, Title IX and Equity Coordinator, Building 100, Room 708, 678.226.6691, lrichardson@gwinnettTech.edu
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