EMT Program, Program Information Request & Paramedic Application Form

Volunteer State Community College | Division of Academic Affairs

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To receive information regarding our EMT and Paramedic Programs or to apply for the Paramedic Program, please complete the following request form.

Please fill in and click the Submit button.

* Represents fields that must be entered to submit this form.
Are you a currently licensed EMT wanting to apply for the next Paramedic Class?	Yes No
If Yes, provide current license number:
Licensed by:	*Please Select AL-Alabama KY-Kentucky NREMT TN-Tennessee Other
Expiration Date (xx/xx/xxxx xx:xx am or pm):
Where did you take your initial EMT training (Name of School)?
Date Completed :
4. Please provide the following contact information:
* Name:
Address:
City:
State:
Zip Code
Country:
* Phone Number:
Work Phone Number:
Fax Number
* E-Mail Address:
If you are NOT currently licensed as an EMT - Please answer the following questions by checking the appropriate response.
Are you at least 18 years old?	Yes No
Do you have a high school diploma or a GED?	Yes No
Do you have any history of a felony conviction?	Yes No
Do you have any physical limitations that would limit your ability to perform heavy lifting or strenuous activity for long periods of time?	Yes No
Have you completed any previous college courses or degree work at Volunteer State?	Yes No
When would you prefer to attend classes?	During The Day During The Evening Weekend Anytime
Where would you prefer to attend classes?	Gallatin - Main Campus (Day or Evening) Nashville - Cohn Adult Learning Ctr (Day Only) Nashville - Hunter's Lane H.S. (Evening) Clarksville - APSU Compus (Evening Only)