Fillable EMS Professions Diploma (EMT Certificate and AEMT Certificate) (Gwinnett Technical College)

Fill Online, Printable, Fillable, Blank EMS Professions Diploma (EMT Certificate and AEMT Certificate) (Gwinnett Technical College) Form

Use Fill to complete blank online GWINNETT TECHNICAL COLLEGE pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

EMS Professions Diploma (EMT Certificate and AEMT Certificate) (Gwinnett Technical College)

On average this form takes 13 minutes to complete

The EMS Professions Diploma (EMT Certificate and AEMT Certificate) (Gwinnett Technical College) form is 2 pages long and contains:

  • 2 signatures
  • 7 check-boxes
  • 42 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Gwinnett Technical College

BROWSE GWINNETT TECHNICAL COLLEGE FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
LAWRENCEVILLE I ALPHARETTA -NORTH FULTON
□
□
□
□
□
I
□
□
EMS Professions Diploma
(EMT Certificate and AEMT Certificate)
2 semesters
Program Advisement Form
The Program Advisement Form is required for admissions to the EMS Professions Diploma.
Students must be accepted to the EMS Professions Diploma or Interdisciplinary Degree/Emergency Medical Services.
Please complete Applicant Information below:
First Name Middle Name Last Name
Student Number:
Address City State Zip code
Phone:
GTC Email Address
Alternate Email Address
Please select the Campus and Start Term for which you are applying:
LAWRENCEVILLE CAMPUS - Please select your start term & note the application deadline
Summer Semester: March 22
Prerequisite Deadline: End of Spring Term
Night classes; 3/week
Fall Semester: June 1
Prerequisite Deadline: End of Summer Term
Day classes; 2/week
ALPHARETTA - NORTH FULTON CAMPUS - Please select your start term & note application deadline
Spring Semester: October 10
Prerequisite Deadline: End of Fall Term
Day classes; 2/week
Fall Semester: June 1
Prerequisite Deadline: End of Summer Term
Day classes; 2/week
Please read and initial each of the following:
____ 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 FYES 1000 (unless exempt) must be completed before beginning the program.
_____ I understand completion of prerequisite courses and meeting other minimum requirements does not guarantee
selection to the EMS Professions Diploma program, as there are a limited number of seats available in the
occupational and clinical courses.
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
January 30, 2020
EMS Professions Diploma Prerequisites
*To be completed by Applicant*
Required Prerequisite Course
ENGL 1010: Fundamentals of English I or ENGL 1101 Composition and
Rhetoric I (3)
MATH 1012: Foundations of Math or MATH 1111 College Algebra (3)
PSYC 1010: Basic Psychology (3) or PSYC 1101 Intro to Psychology (3)
FYES 1000: First Year Experience (2)
*ALHS 1090: Medical Terminology for Allied Health Sciences (2)
*ALHS 1011: Structure and Function of the Human Body (5) OR
*BIOL 2113: Anatomy and Physiology I (3); AND
*BIOL 2113/L: Anatomy and Physiology I Lab (1) AND
*BIOL 2114: Anatomy and Physiology II (3); AND
*BIOL 2114/L: Anatomy and Physiology II Lab (1)
*Courses must be completed within 5 years of the program start
Letter
Grade
Semester
Earned or
Completed
IP (in
progress)
Please initial each of the following:
_____ I understand that students applying to the EMS Professions program 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 is in good academic standing
All previous transcripts have been
received
Student has an active Admissions file
Student has “in-progress” classes
All prerequisite courses completed with a minimum
grade of C
# of in-progress courses
Student’s Driver’s License and/or P-Card have not
expired
For staff use only
January 30, 2020
click to sign
signature
click to edit
click to sign
signature
click to edit
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

EMS Professions Diploma (EMT Certificate and AEMT Certificate) (Gwinnett Technical College)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 3 February 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document