________________________ Student ID #
2020 EMS Bridge Application Deadline: Monday, August 3, 2020 at 4pm
Rockingham Community College has the right to change curriculum and admission requirements without prior notice.
EM
E
RGENCY MEDICAL SCIENCE - BRIDGE PROGRAM
Fall 2020 Candidate Review Form
PLEASE
TYPE OR PRINT CLEARLY.
INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED!
FULL Name: _________________________________________________________________
(First) (Middle/Maiden) (Last)
Address: ____________________________________________________________________
City/State/Zip: ___________________________________________________________
County of Residence: ___________________ How long have you lived in this county? _______
Home Phone: __________________________ Cell Phone: ____________________________
RCC Email: ______________________________________________________________________
Personal Email: ___________________________________________________________________
Are you currently enrolled at a college or university (including RCC)? Yes No
College or university currently attending: _______________________________________________
(If you are attending a college other than RCC, please note you will be REQUIRED to submit an official final transcript showing grades
received immediately after the semester has been completed. Failure to do so may result in automatic ineligibility.)
Please list courses in which you are currently enrolled:
CURRENT ACADEMIC INFORMATION
PREVIOUS HEALTH SCIENCE PROGRAM INFORMATION
Excluding your EMS training, have you previously attended or completed a health science program
(nursing, respiratory therapy, surgical technology, phlebotomy, etc.)?
Name of health science program: ______________________________
Name of school attended: _______________
_
_
_
_
_
________________
Dates attended:
_______________________
Did you complete the program?
If yes, dat
e completed: _____
_
_
_
_
_
_
_
_____
If no, reason for non-completion:
No
Yes (if yes, please answer questions below)
No Yes
Minimum Admissions Requirements Check Sheet
DO NOT FILL OUT THIS PAGE!
To be completed by the Assistant Director of Enrollment Services in the Whitcomb Student Center.
Notes
(Staff Use Only)
Requirements
Verification
(Staff Use Only)
Candidate has a RCC Application for Admission on file in the Admissions Office.
________ Application Complete
Official High School/GED and ALL College transcripts are on file in the
Admissions Office. Official transcripts are required. Transcripts must include
paramedic education program.
___HS/GED only
___HS/GED/College
Candidate has provided two (2) letters of recommendation from an
EMS agency on agency letterhead.
____ Verified by Admissions Staff
Candidate is in Satisfactory Academic Standing with Rockingham
Community College (at least a 2.0 RCC GPA or higher).
____ Verified by Admissions Staff
Your signature on this document indicates that the information on this application
is correct and that
you have read and understood the complete admissions information on the Health Sciences webpage.
Student Signature: ________________________________________________________ Date: _____________
Signature of Admissions Staff completing form: _________________________________ Date: _____________
2020 EMS Bridge Application Deadline: Monday, August 3, 2020 at 4pm
Rockingham Community College
has
the right to change curriculum and a
dmissi
on
r
e
qui
reme
nts
w
ithout
prior notice.
Candidate has provided documented evidence of 500 hours of patient
contact at the paramedic level. Letter must be signed by the director of the
EMS agency with with the candidate is affiliated.
____ Verified by Admissions Staff
FINAL APPLICATION ST
EP:
After submitting the Candidate Review Form, candidates must schedule an appointment to meet with Jason Collins, EMS
Program Director. Applicants must met with Jason Collins prior to admission to the program.
JASON COLLINS
Program Director, Emergency Medical Services
collinsj1503@rockinghamcc.edu
(3
36) 342-4261 ext. 2111
Current curriculum English and math placement test scores (or waiver) on file
with the Admissions Office.
____ Verified by Admissions Staff
Candidate has submitted a copy of the paramedic education
transcript and all current certficiations:
North Carolina EMT-Paramedic or National Registry Paramedic
Current Healthcare Provider CPR certification or equivalent
Current Advanced Cardiac Life Support (ACLS) certification or equivalent
Current Pediatric Advanced Life Support (PALS) certification or equivalent
Current Pre-Hosiptal Trauma Life Support (PHTLS) or International
Life Support (ITLS) certification or equivalent
Current North Carolina driver's license
____ Verified by Admissions Staff
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