Fillable Paramedic Program Application Applications Available: Rolling Admission Basis (Anne Arundel Community College)

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Paramedic Program Application Applications Available: Rolling Admission Basis (Anne Arundel Community College)

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Paramedic
Program Application
Applications Available: Rolling Admission Basis
ADMISSION REQUIREMENTS
To become a candidate for selection to the Anne Arundel Community College Paramedic Program, please complete
and return the enclosed application form. The application must be completed and emailed to ramanning@aacc.edu
or mailed to AACC School of Health Sciences, 101 College Pkwy., FLRS 112, Arnold, MD 21012.
Students will be admitted to the Paramedic Program on a rolling admission basis. The program begins in March
and August every year. Applications will be rejected if incomplete. Incomplete applications will be returned to the
student and can be resubmitted once they are complete. A future seat will be slotted for them once they meet the
criteria for admission.
First consideration will be given to candidates whose resident address is in Anne Arundel County for at least three
months prior to the date the application is submitted. The Address Verification form must be submitted with the
application. Out-of-county applicants will be reviewed if space is available.
To be considered for conditional acceptance, the applicant must meet the following criteria:
• If you are submitting an application and have not yet viewed an online or attended a face-to-face Paramedic
Information Session, please visit
http://www.aacc.edu/apply-and-register/credit-application/health-science-
applicants for dates and times to participate in a virtual information session.
• Minimum adjusted grade point average (GPA) of 2.0 at this college.
• Submission of a current Maryland EMT certification or National Registry certification card.
(Conditional
acceptance will be given during the COVID-19 health crisis and state of emergency to those applicants who
have a provisional EMT license. The provisional EMT license holder, once this process is halted by the State of
Maryland, will have 30 days to get a full EMT license in the State of Maryland by passing both the written National
Registry EMT exam and the psychomotor or practical test.)
• Active affiliation as validated by the EMS company officer. Proof of affiliation will be required in order to attend
field clinicals which start in the third month of the program. Affiliation paperwork must be submitted prior to
attendance of any clinical or field assignment. If a student cannot meet any of these provisions by the due date,
the student will forfeit their place in the current paramedic cohort and will be assigned a position in the next cohort
start.
• Arithmetic Placement Test is required with a score of 27 or better, or MAT 005 with a grade of C or better, at the
time application is submitted. Note: You have two attempts to achieve a passing score (27>) on the Arithmetic
Placement Test. Arithmetic Placement Test scores must be within 7 years from the date program application is
submitted. Retake is allowed if test is past this time frame. One retake is allowed after that if needed. There is no
time limit on MAT 005.During the summer 2020 and through at least October 26, 2020 this test will be offered
remotely, please email testing-arnod@aacc.edu
for an appointment.
• Complete prerequisite courses with a grade of C or better prior to submitting the Paramedic application. Pass/Fail
grades will not be accepted.
• Demonstrate eligibility for English 101/101A.
• Degree-seeking applicants must demonstrate eligibility for MAT 135, Statistics.
• For State certification students must be at least 16 years of age. Regulations for National certification require
students to be at least 18 years of age.
• If you have 27 or more college credits with a grade of C or better (transferred to AACC or taken at AACC) and
have a GPA of 2.0 or higher, you do not need to take ACA 100. Requirements must be met prior to submitting
application.
Eligible applicants will receive a selection packet assigning them to one of the following categories:
o Conditional Acceptance: Applicants who have met the academic and admission requirements and have
been selected into the program are given conditional acceptance. Students who are granted conditional
acceptance must submit a criminal background check, CPR certification and health examination record
by designated deadlines. Students who do not meet these deadlines will not be further considered for
admission.
o Wait List: In the event there are more qualified applicants than seats available, qualified applicants not
initially selected for conditional acceptance will be placed on a wait list according to the date and time
applications were received and notified for selection accordingly. If applicant declines the seat, they
will need to reapply for future seat.
Final acceptance in the program will be contingent upon satisfactory completion of a criminal background check, a
health examination record and a drug screen and submission of a copy of the required CPR card. If deadlines are
not met, applicant will lose their seat. Upon receipt of the application, students will receive an email sent to their
AACC email account regarding the status of their application.
IMPORTANT INFORMATION
1. Direct all inquiries regarding the application process to the Health Sciences Admissions office via email at
ramanning@aacc.edu
.
2. All Health Sciences students who are offered admission and/or clinical placement will be required to submit a
complete criminal background check and urine drug screen. All student applicants’ final acceptance in the program
shall be contingent upon satisfactory completion of a criminal background check and of a urine drug screen.*
All letters of acceptance shall state that the acceptance is conditional and contingent on submission of a criminal
background check and urine drug screen–as may be required by the program–that results in satisfactory reports. If
an accepted student tests positive for an illegal or un-prescribed drug, the student shall be denied admission or
terminated from any Health Sciences program.
Separate, additional criminal background checks and urine drug screens may be required by clinical sites prior to
placements. Students with an unsuccessful background check or urine screening who are denied by a clinical site
that is required to meet program competencies shall be dismissed from the program and their registrations shall be
withdrawn from courses related to the program of study. If the student tests positive for an illegal or un-prescribed
drug, the student shall be denied admission or terminated from any Health Sciences program even if a denied
placement was not required to meet program competencies. Successful reports of criminal background checks and
urine drug screens do not assure eligibility for specific clinical site placement, program completion, and/or eligibility
to sit for professional licensure/board examinations.
Students are reminded that licensing boards for certain health care occupations and professions may deny,
suspend, or revoke a license or may deny the individual the opportunity to sit for an examination even if the individual
has completed all program course work if it is determined that an applicant has a criminal history or has been
convicted of, or pleads guilty, or pleads nolo contendere or the like to a felony or other serious crime.
Successful completion of a Health Sciences program of study at Anne Arundel Community College does not
guarantee licensure, the opportunity to sit for a licensure examination, certification or employment in the relevant
health care occupation.
Students may be automatically denied admission or, if enrolled, dismissed from the program if they have not been
truthful or have provided inaccurate information on the application or on any other form or submission. Students
who have questions or concerns are encouraged to contact the Health Sciences Admissions Office at
healthsciencesadmissions@aacc.edu
.
* Notwithstanding the statements herein regarding urine drug screens, as of September 2010, only certain
programs will be requiring drug screening. AACC shall inform students which programs presently require
them. However, AACC, at any time, has the right, upon notice, to require any and all students and any and
all programs to comply with drug screening. (Paramedic students are required to do urine drug screening
on admission)
05/2020
PARAMEDIC
ROLLING ADMISSIONS
PROGRAM APPLICATION
Applications are accepted for the Paramedic Program on a rolling admission basis for program selection. The
program begins in March and August each year. Students need only apply once to the program, providing their
application is complete. A future seat will be slotted once the applicant meets the criteria for admission.
If you have previously submitted your official transcript(s) from other institutions to Records and Registration at
AACC, it is your responsibility to ensure that the transcript(s) have been posted by the time you submit your
application. If the official transcript(s) are not posted, the application will be considered incomplete and will be
returned.
Completed applications are to be emailed to ramanning@aacc.edu
or mailed to AACC School of Health Sciences,
101 College Parkway, FLRS 112, Arnold, MD 21012.
I PLAN TO PURSUE:
☐
Degree Option
☐
Certificate Option
Demographic Information
Last Name
First Name
Middle
Address
City
State
County
Last 4 digits of social security #
College ID #
The mailing address you provide on this application will be your address of record. It is your responsibility to
notify the Health Sciences office as well as the Records office of name, address and phone number
changes during the application process.
Home Phone
Cell Phone
Work Phone
AACC Email Address – Required No other email is acceptable
@mymail.aacc.edu
Print clearly
Applicants are advised to check their AACC email account periodically for placement and updates.
By signing below, I agree/understand the following:
1. I have an active admission status at AACC and am in Good Standing (2.0 GPA>) with the college.
2. I have submitted final official transcripts* from ALL previously attended colleges and, if needed, high school
transcript to the Records and Registration office.
International
students must submit official transcript evaluation
report from ECE, WES or SpanTran to verify /authenticate your high school and/or college transcripts, if
applicable. It is not necessary to submit AACC transcripts.
3. If information is missing from my application, record or file it will NOT be processed and will be returned to me.
Incomplete applications will NOT be considered.
4. Copies of any additional requested documents are attached with this application including supporting address
verification documents.
5. I understand that by filling in my name below, it will be considered my signature.
Signature: Date:
*Official transcripts are received by Anne Arundel Community College in the sending institution’s original sealed
envelope or sent electronically from sending institution.
ARITHMETIC PLACEMENT TEST - This is not the same as the Mathematics Placement.
This test may only be taken two times. Failure to achieve a passing score (27 or better) after two attempts will
require completion of Math 005 with a grade of C or better prior to application submission. Note: *The APT must
be taken within 7 years from date of application submission. There is no time limit on MAT 005.
APT SCORE:
M
ATH 005 - Must provide official transcript if taken at institution other than AACC
GRADE: WHERE TAKEN:
Paramedic REQUIREMENTSPARAMEDIC ADMISSION REQUIREME
EMS AFFILIATION:
EMS Officer’s Name:
Must attach a copy of current state EMT Certification or National Registry Card to application. (See
application letter for information on provisional license during the COVID-19 health crisis and state of
emergency.)
Name:
Pass/Fail grades are not accepted for this program
PREREQUISITE COURSES Must be
complete prior to application submission
with a grade of C or better
GRADE CREDITS
EARNED AT
COLLEGE/UNIVERSITY
TERM &
YEAR
COMPLETED
++ACA
100 (Student Success Seminar)
++ACA 100 Students who have earned 27 college credits with a grade of C or better with a cumulative GPA of 2.0 or higher do
not need to take ACA 100
Must complete one of the following Biology courses:
BIOLOGY 230 (Structure and Function
of the Human Body) or
BIOLOGY 232 (Human Biology 2) or
BIOLOGY 234 (Anatomy and
Physiology 2)
General Education Requirements: Degree-Seeking Students Only
Statistics
MAT 135
Academic Writing and Research 1
ENG 101/ENG101A
Academic Writing and Research 2
ENG 102
Introduction to Sociology
SOC 111
Computer Fundamentals
CTA 100 (Formerly CSI 112) OR
CTP 103 (Formerly CTA 103)
Introduction to Interpersonal
Communication
COM 111 OR COM 116
OR COM 110
OR COM 141
NOTE:
Licensing boards for certain health care occupations, including Paramedic, may deny, suspend, or revoke a
license or may deny the individual the opportunity to sit for an examination, even if the individual has completed all
program course work, if it is determined that an applicant has a criminal history or is convicted or pleads guilty or
nolo contendere to a felony or other serious crime. If applicable, it is recommended to contact the Maryland Institute
for Emergency Medical Services Systems for clarification at 410-706-3666.
I certify that the information on this application is true and accurate to the best of my knowledge. Falsification or
misrepresentation of any information on this application may result in being denied admission to the program. I
understand that final acceptance into the Paramedic program shall be contingent upon satisfactory completion of a
criminal background check and satisfactory completion of a health examination record.
I understand that by filling in my name below, it will be considered my signature.
Signature: Date:
Notic
e of Nondiscrimination: AACC is an equal opportunity, affirmative action, Title IX, ADA Title 504 compliant institution. Call Disability
Support Services, 410-777-2306 or Maryland Relay 711, 72 hours in advance to request most accommodations. Requests for sign language
interpreters, alternative format books or assistive technology require 30 days’ notice. For information on AACC’s compliance and complaints
concerning sexual assault, sexual misconduct, discrimination or harassment, contact the federal compliance officer and Title IX coordinator
at 410-777-1239, complianceofficer@aacc.edu or Maryland Relay 711.
BACKGROUND INFORMATION
Submit explanation of questions for which you answer "yes" and provide documents relating to your answer in
a sealed envelope attached to this application. Attention: Tammie Neall
Do not write explanation(s) on the application.
Yes
No
Were yo
u ever disciplined for any academic or behavior/conduct issue by any college,
university, or any other educational institution after high school including, but not limited to,
probation, dismissal, suspension, disqualification, or imposition of a failing grade as a
disciplinary sanction? If your answer is yes provide a written explanation and all relevant
documents relating thereto.
Yes
No
Have
you ever been convicted of a crime, driving while intoxicated or impaired (either by
alcohol
or drugs), had your driving privileges suspended or revoked, and/or are there any
pending
charges regarding any of the above? If your answer is yes provide a written
explanation
and all relevant documents relating thereto.
Yes
No
Have
you ever surrendered your driver's license or had such license suspended or revoked?
If
your answer is yes provide a written explanation and all relevant documents relating
thereto.
Yes
No
Have
you ever surrendered a professional license, certification or registration, or had one
restricted,
suspended or revoked? If your answer is yes provide a written explanation and all
relevant
documents relating thereto.
Yes
No
Have
you ever been placed on professional probation, had conditions or limitations placed
on
your ability work even if your license had not been restricted, suspended or revoked? If
your
answer is yes provide a written explanation and all relevant documents relating thereto.
Yes
No
Have you ever had your clinical privileges at any office or facility restricted, suspended or
revoked? If your answer is
yes provide a written explanation and all relevant documents
relating thereto.
ANNE ARUNDEL COMMUNITY COLLEGE
PARAMEDIC PROGRAM
AFFILIATION VERIFICATION
Please check one:
ALS BLS
Name:
Last four digits of Social Security #:
Affiliation #:
Affiliation Name:
Address:
Telephone #:
Company Verification
To be completed by the company senior EMS officer.
I verify that the candidate named in above is currently an active member/provider
holding membership as of this date. This company approves of this individual’s
participation in EMS training and/or verifies that this individual will be providing EMS
care as a member of this company.
Affiliation Company:
Signature: Date:
PRINT NAME:
Title:
Student’s Signature:
101 College Parkway, Arnold, Maryland 21012-1895 410-777-2243
ADDRESS VERIFICATION FOR HEALTH SCIENCE PROGRAM APPLICANTS
Directions: This form must be completed entirely and supporting documents submitted as part of the health sciences
program application process. Applications submitted without this document will be returned as incomplete.
If you the student support yourself, provide a minimum of two of the documents listed below in your name, at current
resident address that are dated three months prior to the application deadline date.
OR
If for the most recent 12 months, you, the student, have resided in Anne Arundel County, but are supported by someone in
another Maryland county or state, provide a minimum of two of the documents listed below in your name, at current resident
address that are dated three months prior to the application deadline date.
OR
If for the most recent 12 months, another person(s) has provided one-half or more of your financial support, provide a
minimum of two documents listed below in your supporter’s name, showing current resident addresses that are dated three
months prior to the application deadline date.
In addition, you will need to provide one document from the list below in your name showing current resident address and
dated three months prior to the application deadline date in addition to the two documents from your supporter. The
supporter must also complete the information requested in Section B.
Military Personnel Only:
Complete this form with a copy of your military ID (also dependent ID, if spouse or dependent), copy of orders, and a copy
of housing assignment, lease, deed or utility bill showing your resident address.
Example: All documents must be dated three months prior to application submission date.
Acceptable Documents
• Maryland Driver’s License
• Voter Registration Card
• Copy of Deed of Trust or Signed Lease
• Maryland Withholding Form – MW 507 (Not U.S. W-2)
• Maryland Income Tax Return (not U.S.)
• Utility Bill including gas, electric, water, phone, cable, etc.
• Vehicle Registration Card
The college reserves the right to request additional information and documentation as necessary.
SECTION A – TO BE COMPLETED BY STUDENT
Student Name
Student ID or SSN (last 4 digits)
Resident Address
City
State
Zip
County
Day Phone
Evening
Dates of Occupancy at above address
Own
Rent
Previous Address
City
State
Zip
How long did you live at this previous address?
Are you registered to vote?
Yes
No
County
State
Do you possess a valid driver’s license?
Yes
No
If yes, what state issued?
County
Date of Issuance
OFFICE USE ONLY
Program and Term:
Do you own a motor vehicle? Yes No
If yes, in what state issued? County Date of Issuance
Do you have the use of another person’s motor vehicle? Yes No
If yes, provide name Relationship to student
Are you paying Maryland income tax for this year on all earned income? Yes No
If yes, what county?
List where you have filed tax returns for the past two (2) years:
Year State County
Year S
tate County
If employed, is Maryland income tax currently being withheld? Yes No
If yes, what county?
For the most recent 12 months, has another person(s) provided one-half or more of your financial support?
*Yes No
*If the answer to the above question is “Yes”, SECTION B of this form must be completed by your supporter.
Additional Information
The college reserves the right to request additional information and documentation as necessary.
I CERTIFY THAT THE INFORMATION CONTAINED HEREIN IS CORRECT TO THE BEST OF MY KNOWLEDGE.
Signature of Student (required) Date
OFFICE USE ONLY
ACCEPTABLE DOCUMENTS: MILITARY/BRAC WAIVER:
____ MD driver’s license ____ Military ID (& Dependent ID if spouse or dependent)
____ MD income tax return (not U.S.) ____ Copy of Orders
____ Voter Registration Card ____ Copy of housing assignment, lease, deed or utility bill
____ Vehicle registration showing resident address
____ Utility bill showing home address
____ Copy of deed of trust or signed lease
____ MD withholding form – MW 507 (not U.S. W-2)
STATUS OF RESIDENT ADDRESS
Anne Arundel County Other MD county Out-of-State Term & Year
Authorized signature: Date:
SECTION B
TO BE COMPLETED BY SUPPORTER IF YOU ANSWERED “YES” to the following questio
n:
For the most recent 12 months, has another person(s) provided one-half or more of your financial support?
Name of supporter Relationship to student
Supporters Address
City State Zip
County Day Phone Evening
Date of Occupancy at above address
Own
Rent
Previous Address
City State Zip
How long did you live at this previous address?
Are you registered to vote? Yes No County
Do you possess a valid driver’s license? Yes No
If yes, in what state issued? County Date of Issuance
Do you own a motor vehicle? Yes No
If yes, in what state issued? County Date of Issuance
Do you have the use of another person’s motor vehicle? Yes No
If yes, provide name Relationship to student
Are you paying Maryland Income tax for this year on all earned income? Yes No
If yes, which county?
List where you have filed tax returns for the past two (2) years:
Year State County
Year S
tate County
If employed, is Maryland income tax currently being withheld? Yes No
If yes, in which county?
Additional information:
The college reserves the right to request additional information and documentation as necessary.
Signature of supporter: Date:
Notice of Nondiscrimination:
AACC is an equal opportunity, affirmative action, Title IX, ADA Title 504 compliant institution. Call Disability Support Services, 410-777-2306 or
Maryland Relay 711, 72 hours in advance to request most accommodations. Requests for sign language interpreters, alternative format books or
assistive technology require 30 days’ notice. For information on AACC’s compliance and complaints concerning sexual assault, sexual misconduct,
discrimination or harassment, contact the federal compliance officer and Title IX coordinator at 410-777-1239, complianceofficer@aacc.edu or
Maryland Relay 711.
G:\ALHEALTH\HDrive\AHCOMMON\TDN\Admissions Forms\Residence Petitions by Program\Residence Petition Template 5.22.2020
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Paramedic Program Application Applications Available: Rolling Admission Basis (Anne Arundel Community College)

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Completed 22 July 2020

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