Community College
Paramedic Program Online Application

Email address:
Daytime phone
Street Address
City, State  Zipcode
Date of Birth
Are you currently certified as an
EMT-Basic in NY?  If so, for how long
and what kind of field experience do
you have (where and for how long)?
What kind of academic background do
you have?  Specifically, have you
taken any college level Math or English
Have you taken Anatomy and
Physiology I and II before (at any
college)?  If so, did you get a C or
better in each?
When do you anticipate reaching the
"third semester" or Paramedic 1&2
classes?  Fall 2008, Fall 2009 or later?