2016 St. Francis Paramedic Program
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- Verity Cox
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1 2016 St. Francis Paramedic Program Are YOU ready to become a Paramedic? Top 5 reasons YOU should come here: % of our graduates pass the National Registry (most on their FIRST attempt) * % of our graduates successfully find EMPLOYMENT as Paramedics * 3. We employ enthusiastic Paramedics DEDICATED to helping you learn on 911 calls 4. We have the facilities, resources and EXPERIENCED instructors to help you succeed 5. We were one of the FIRST accredited programs in the state * Data from 2011 to present [ Applications Due June 17 ] Did YOU know We have NO HIDDEN program costs Our style of education is student-lead learning No less than half the day is spent on active learning, real-life scenarios, and skill mastery Our students enjoy supplementing their books with an online learning management system Our facilities have wireless internet For a minimal fee, students have fitness center access Tuition includes ACLS, PALS, and ITLS classes We work closely with the VA so YOUR military benefits can help pay for school We spread out tuition payments over several months FRANCISCAN ST. FRANCIS 8111 S. EMERSON AVENUE INDIANAPOLIS, IN EDUCATION CENTER 421 N. EMERSON AVENUE GREENWOOD, IN Facebook: FranciscanStFrancisEMS Continuing Christ s Ministry in Our Franciscan Tradition Request an Application from: Sara.Brown2@FranciscanAlliance.org Class meets M & Th Conveniently located off I-65 Classroom portion <12 months (incl. precourse) Competitive entrance process includes: testing, interview, and precourse Starts with precourse, allowing YOU to try it out before full financial commitment Program Cost $4800 Scholarships and Discounts available Application Fee $50 All program specific uniform elements included Laptop or tablet strongly suggested address and printer access required EDUCATION CENTER (ESSC) I-65 AND COUNTY LINE ROAD
2 Application Instructions Application instructions: 1. Follow all directions and ensure the application is complete. 2. Include the following items: $50.00 (non-refundable) application fee Affix a recent photo in the space provided on Page 3 Copy of valid Driver s License or Government-issued ID Proof of secondary school graduation Copy of State of Indiana EMT Certification Copy of CPR card (Healthcare provider or Professional rescuer level) Financial Assistance Declaration must be completed accurately Copy of ISP Limited Criminal History Record ( ($16.32 fee) (If applicable) Any explanation/documentation related to arrests 3. Completed applications must be received no later than: June 17, 2016 at 1200 hrs. 4. Applications may be submitted by either of these means: US Mail to: Franciscan St. Francis Health EMS Education 8111 S Emerson Avenue Indianapolis, IN, ATTN: Sara Brown Hand Delivered: To Any Full-Time EMS Education Staff Member by appointment. PLEASE RETAIN PAGES 1 AND 2 FOR YOUR REFERENCE DO NOT SUBMIT THEM WITH YOUR APPLICATION. Selection Process You will be contacted by regarding scheduling your FISDAP Paramedic Entrance Examination and interview. The FISDAP Exam is a computer-based test which includes A&P, Reading, Math, and EMT knowledge. Within 7 days of notification of acceptance into pre-course, a $ non-refundable deposit is due to secure your position. This deposit will be applied toward the first tuition installment. Accepted applicants are required to attend Survival Night on Tuesday, September 6, 2016 at Family members are strongly encouraged to attend, as well, to learn about the program and expectations. Classes will begin Monday, September 12, Page 1 of 6
3 Costs The cost for this program (pre-course and course) is $4,800.00: Tuition $3, Classroom Instruction Lab Instruction Clinical and Field Instruction Sub-course Instruction (ACLS, PALS, ITLS) Educational Tools $ Required Textbooks FISDAP Online Learning Management System Uniforms Supplies $ Use of Equipment Medical Supplies ID Badge Financial Considerations Photocopied class handouts Organic and other perishable materials Payments will be remitted in four equal installments due by the following dates (without exception): September 12, 2016 $1, ($ deposit is applied to this installment) November 7, 2016 $1, January 9, 2017 $1, March 6, 2017 $1, Two $ scholarships are awarded to the individuals who receive the highest scores in the application process. Discounts are available for persons who: successfully completed EMT class at Franciscan St. Francis work full-time for Franciscan St. Francis Health work full-time for any of our affiliated provider organizations work full-time for any of our precepting sites are referred to this program as part of our community outreach program Only one discount is allowed per student. Documentation of eligibility is required. If an employer or another 3 rd party will be contributing to the payment of tuition, timely payment and ALL correspondence will remain the sole responsibility of the applicant/student. Questions regarding the program or application process may be directed to: Sara Brown Sara.Brown2@FranciscanAlliance.org Page 2 of 6
4 Attach Photo Here EMS Education Instructions for completion: 1. Complete every area of the application. 2. Type or print legibly. Use care the page breaks do not change. 3. Enclose all requested documentation. Personal Data Name: Last First Middle Address: Primary Phone: Secondary Phone: address (required): Current Employer: Employer Address: Work Phone: Length of Employment FT / PT (If more than one, check here and list separately) EMERGENCY NOTIFICATION Primary Name: Relationship: Primary Phone: Secondary Phone: Secondary Name: Relationship: Primary Phone: Secondary Phone: CRIMINAL HISTORY (include copy of Driver s License) Do you have any pending criminal charges or felony convictions? Yes No If yes, please attach a complete explanation to this application. Page 3 of 6
5 _ APPLICANT LAST NAME EMS Affiliation Data List ALL Previous EMS Employers (If more than two, check here and list separately) 1) Employer Name: Employer Address: Length of Employment: Part time Full time Supervising Hospital: Supervisor: Contact Information: 2) Employer Name: Employer Address: Length of Employment: Part time Full time Supervising Hospital: Supervisor: Contact Information: High School Graduate or Month / Year Educational Background GED (Include H.S. diploma or GED) Month/Year Post-secondary Education: Some college credit Associate s Bachelor s Post-Graduate work EMT Course: Training Institution:_ Primary Instructor: s of Course: Indiana PSID number: Expiration : (include copy) Nationally Registered: Yes No Registry Number: Exp. : Additional EMS Certifications: [i.e. CPR (include copy), Emergency Driving, PI, etc.] Page 4 of 6
6 Financial Assistance to Paramedic Students from 3 rd Parties _ APPLICANT LAST NAME The Family Education Rights and Privacy Act (FERPA) is a Federal Law designed to protect the privacy of a student s education records. This act protects your personal and educational information from being disclosed to third parties. If those third parties require access to this information as a condition of providing financial assistance, the student must give permission in writing. If payment is received from any source other than the student, either a FERPA form must be submitted granting that source access to education records or the source must agree in writing they will have no access to the student s education records. Please select the box which best applies to your situation: I WILL be receiving financial assistance, and my source will agree in writing they will have no access to my education records. I require NO FERPA release form. Source of financial assistance: _ I WILL be receiving financial assistance and WILL require a FERPA release form. Source of financial assistance: _ All payments will come directly from me. I require no FERPA release form. Printed Name Page 5 of 6
7 Student Health Record I understand that if accepted into the program. I will be required to provide health and vaccination records. Course Policies I have received a draft copy of the course policy manual. I understand this is a draft and the final version will be provided to me no later than the first day of class. Release of Information Authorization I authorize any: Current or former employers Current or former affiliating hospitals Current or former training institutions Sites of educational experiences Personal or professional references (if submitted) to furnish Franciscan St. Francis Health EMS Education with information regarding my performance and/or records of my achievements and standings. I release them and Franciscan St. Francis Health from any and all liability whatsoever. I understand that a copy of this document may be sent to any institution or individual named in this application and any included documentation. Integrity Statement I certify that the information contained in this entire application is true and complete to the best of my knowledge. I realize that any misrepresentation of facts whether intentional or unintentional, found at any point, may lead to the rejection of this application or immediate dismissal from the program without refund. I understand that final selection is contingent upon satisfactory completion of all portions of the competitive application process. Printed Name Page 6 of 6
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