EMS Education Course Enrollment

Thank you for taking an interest in one of our professional EMS Programs. If you would like to know more information about the courses or academies STAT offers, please complete the form below in its entirety and an EMS Education Representative will contact you.

Please allow 24 - 36 hours after submittal for a response from our EMS Education Department.

EMS Program Enrollment Form:
First Name*:
Last Name*:
Are you 18 years of age or older?* Yes      No
Do you have a high school diploma or GED?* Yes      No
Do you have a valid driver's license? * Yes      No
If you are EMR or higher what department are you on?
Have you ever had a felony/misdemeanor conviction?* Yes      No
Which course or Academy are you registering for?
  You must specify the program, i.e. AHA CPR. EMR, EMT-Basic, Paramedic, PHTLS or PEPP. If you are enrolling in an EMT-Cadet Program please indicate the specific cadet academy #, i.e. #19, #20, etc.
Any item marked with a * is REQUIRED  Incomplete enrollment forms will not be addressed.