Phoenix College Paramedic Education Program
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1 Phoenix College Paramedic Education Program PHOENIX COLLEGE Emergency Response Programs 1202 West Thomas Road Phoenix, Arizona Office Fax CAHHEP Program # Phoenix College will be conducting Paramedic Education Program that is open to qualified candidates. The program timeline is listed below; all interested parties are encouraged to make application (found at phoenixcollege.edu in the blog section or on PC EMT website). The process will consist of a completed application, and a written test. The written test will be based on the National EMS Educational Standards for EMT; any EMT text published after 2011 will suffice as study material. Applications will be available for interested candidates; deadline for submission is January 17, Applications may be picked up and submitted at the EMT/Fire Science office at Phoenix College or online at the EMT/FSC. December 30, 2017 An informal information session will be held at the Phoenix College located on the campus in the PS Building room 20. Attendance is not required but is strongly encouraged, family members are also welcome to attend with potential candidates. During this session program goals, expectations, and strategies for success in the written examination will be discussed. January 19, 2017 The written test will be conducted at Phoenix College in the PS Building Rm 24 at 9:00 am. The test will consist of 150 questions from the National EMS Educational Standards for EMT including multiple choice and scenario based questions. Be prepared to show either a driver s license or government issued ID for entrance. It is the policy of Phoenix College and The Maricopa County Community College District to promote equal employment opportunities through a positive continuing program. This means that Maricopa will not discriminate, nor tolerate discrimination, against any applicant or employee because of race, color, religion, gender, sexual orientation, national origin, age, disabled, or veteran status. Additionally, it is the policy of Maricopa County Community College District to provide an environment for each Maricopa job applicant and employee that is free from harassment, as well as harassment and intimidation on account of an individual's race, color, religion, gender, sexual orientation, national origin, age, disabled, or veteran status.
2 PARAMEDIC EDUCATION PROGRAM APPLICATION FORM Name: Last First/Middle Current Address: Street City State Zip Code Contact Numbers :( ) ( ) ( ) Home Work Cell Phone or Pager Address: Home Work EMT Certification Number: EMT Certification Date: EMT Certification Expiration Date: List all colleges/universities and degrees earned: Institution Date of Attendance Degree earned Institution Date of Attendance Degree earned Institution Date of Attendance Degree earned The following courses are preferred but not required: Have you attended a course in ECG recognition: Y / N Date: Grade: Have you attended a course in Pharmacology: Y / N Date: Grade:
3 1 List all Current Certifications and EMS Courses Completed: I UNDERSTAND THAT I MUST BE CERTIFIED AS AN EMT AND CURRENTLY CERTIFIED AS AN EMT, AEMT OR IEMT IN THE STATE OF ARIZONA. ALL OF THE INFORMATION IS TRUE TO THE BEST OF MY KNOWLEDGE AND THAT FALSIFICATION COULD MEAN DISMISSAL FROM THE PARAMEDIC EDUCATION PROGRAM. Signature of Applicant Date Phoenix College is accredited by the Commission on Accreditation of Allied Health Education Programs ( program # ) upon the recommendation of the Committee on Accreditation of Educational Programs for the Emergency Medical Services Professions (CoAEMSP). Include the following items with your application: Copy of your current CPR card (front and back) Copy of your current Arizona EMT-B certification card Two letters of support from currently certified paramedics and/or supervisor Any transcripts from colleges/universities attended (unofficial transcripts accepted) Completed Physical/Immunization forms Copy of Haz-Mat First Responder Certification, enrollment in (FSC105) or Proof of Transcript APPLICATION DEADLINE ISON THE DAY OF THE WRITTEN EXAMINATION. Your application may also be mailed to: Phoenix College EMT/FSC Dept. Attention: Gene McDaniel BS, NRP Emergency Response Program Director 1202 W. Thomas Rd. Phoenix, Az
4 Name: Address: DOB MM/DD/YY: City: State: Zip Code: HAVE YOU HAD OR DO YOU HAVE: YES NO Vision or Hearing problems Heart Problems Childhood diseases Epilepsy, Diabetes, High Blood Pressure, Kidney problems Bone/joint disease or injury, back injury Serious Injuries/Major surgery, Hernias Mental Illness/Nervous Disorder Drug/Alcohol problems Lung disease Skin problems/diseases I hereby certify that this information is true to the best of my knowledge. Student Signature Date
5 FOR PHYSICIAN USE ONLY PATIENT NAME AGE HEIGHT WEIGHT PHYSICAL EXAMINATION DATE: HEENT: Lungs: Heart: **Pulse: **BP: Abdomen: Extremities/Joints: Neurologic/Mental: **Vision: R L **Corrected: R L (**indicates the numerical assessment must be documented) Based on this physical, do you find any reason why this person cannot physically perform these activities? Yes No If yes, please explain: Name: (Please Print) MD, DO, PA, FN Signature: Address: City: State: Zip Code:
6 EMERGENCY MEDICAL TECHNOLOGY IMMUNIZATION RECORD I, Print Name (last, first, MI) Signature give permission to to complete this form and release this information to Phoenix College. DATE: ************************************************************************************************* REQUIRED: 1. Tuberculin Intermediate Skin Test (PPD): (Must be good thru March 2008) Date Result (Optional): Chest X-Ray Date Result 2. One of the following Rubella Titer: Date Result (German Measles) Rubella Vaccine: Rubeola Titer: Date Date Result (Measles) Rubeola Vaccine: M.M.R. Vaccine: Date Date 3. Date when you had the Chicken Pox: OR Varicella Titer: Date Result (Chicken Pox) Varicella Vaccine: Date Phoenix College Emergency Response Programs (602)
7 4. Hepatitis B Vaccine (HBV) Series Highly Recommended, but Not Required. If you elect not to receive the HBV vaccination you must to sign the Hepatitis B Vaccination Declination Form (attached). The HBV Series Is a 3 Step Process for Each Portion of the Vaccination Date: Date: Date: 5. Current Influenza Vaccination Date: If you Elect Not to Receive the Influenza Vaccination You Must Sign the Influenza Vaccination Declination Form (attached). Phoenix College Emergency Response Programs (602)
8 Paramedic Education Program Checklist Starter Items for Candidates 1. Complete the ACCUPLACER test or complete RDG101, or have successfully completed the EMT National Registry Test with-in the last 2 years, or possess an AA degree or higher from an accredited college or university. 2. Be currently certified as an EMT in the state of Arizona with the Arizona Department of Health Services, Bureau of EMS. Be prepared to show validation of certification card on day one of class. 3. Possess a current CPR card at the Health Care Provider or Professional Rescuer Level from an organization that follows the American Heart Standards. (ie. AHA, ASHI, ACEP). 4. Obtain a physical assessment by a licensed medical professional either a MD, DO, NP, or PA. Have the provider complete the assessment form and bring it day one of class. 5. Obtain all documentation of update to date immunizations and complete the immunization form. Bring validating proof of immunizations and completed form on day one of class. 6. Complete the application and turn it into the staff on the day of the entrance examination. 7. Discuss finance options with student financial aid (go to fasfa.gov and create the account now and submit application): Phone: (602) pc-finaid@phoenixcollege.edu Location: Hannelly Enrollment Center Hours: Spring & Fall: Mon-Thu: 9:00 AM - 4:00 PM Fri: 10:00 AM - 4:00 PM Summer: Mon - Thu 8:00 AM - 6:00 PM
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