Advanced Emergency Medical Technician (AEMT) Applicant,

Advanced Emergency Medical Technician (AEMT) Applicant, Thank you for choosing Aims Community College for your Educational needs. We are proud to announce our next AEMT rotation beginning Fall Semester 2018. Included with the application itself, you will find the following topic items as well as the appropriate page number for each of those items. Each item has also been hyperlinked to the appropriate section, so you can immediately navigate to a specific section without having to scroll through each page. To come back to the top of the application simply click on the "" hyperlink located at the bottom of each page. Please take the time to read through everything and understand the requirements of the AEMT Program before submitting to a Hirerite Background Investigation and Drug Screen. When turning in the completed application, be sure to include all documents that require a signature. Once again, thank you very much for your interest in our AEMT Program and we look forward to providing you an excellent AEMT Education! Respectfully, Aims Community College Topic Page Number Information: Description of the AEMT Program Page 2 Information: Schedule of the AEMT Program Page 3 Information: Admission, Interview, & Assessment Requirements Page 3 Application Page 4 Application - Admission Essay Page 5 Application - Required Documentation Pages 6 Application - Background Disqualifying Offenses Page 7-8 Application - Consent & Release - Background Pages 9 Application - Consent & Release - Drug Screen Pages 10 Application - Immunization Requirements Page 11 Application - Advising Acknowledgement Form - Clinical Expectations Pages 12 Aims Community College: AEMT Program Application - 2017 to 2018 Cycle Page 1 of 12

Please direct any questions you may have regarding our program or the application process to: Rob Willits AEMT Program Instructor (970) 378-3550 rob.willits@aims.edu Important Application Process Dates to Remember: April 9, 2018: Application packets due. April 16, 2018: Applicants will be notified of confirmation to participate in Interview & Exam. April 24, 2018: Oral Interviews & Entrance Exam testing. April 30, 2018: Notification of acceptance into the program. August 20, 2018: Classes Begin. Please return your completed application to: Aims Community College PSI P.O. Box #69 5401 W. 20 th Street Greeley, CO. 80632 Attn: Rob Willits Or Email to: rob.willits@aims.edu Description of the AEMT Program: The Aims Community College AEMT Training Program has been developed to provide initial AEMT Education to the general public. It is designed to provide instruction based on the: National Education Standards: Aims Community College agrees to meet or exceed the requirements for AEMT Training Center recognition set forth by the State of Colorado Department of Public Health Pre - Hospital Care Program: Colorado Department of Public Health & Environment: EMS Division The overarching goal of the program is to prepare competent, entry - level Advanced Emergency Medical Technicians in the cognitive (knowledge), psychomotor (skills), and affective (behavior) learning domains. Aims Community College: AEMT Program Application - 2017 to 2018 Cycle Page 2 of 12

About the AEMT Program: The Aims Community College AEMT Program includes on-line lecture classes, lab classes, and both in hospital and ambulance clinical rotations. All classes will be taught as hybrid on-line/face-to-face and meet every Monday and occasional Tuesdays all day throughout the semester. Students are required to have computer access to complete the on-line portions of the course. Students will be placed in their AEMT Internship rotations by the Clinical Coordinator of the AEMT Program. Schedule of the AEMT Program: Courses will run consecutively throughout the semester. Any student who fails a course will not be allowed to move on and will need to repeat the program. Class meeting dates are as follows: EMS 131 Fundamentals: 8/20, 8/27, 9/4, 9/10 EMS 127 Operations: 9/17, 9/24, 10/1 EMS 129 Pharmacology: 10/8, 10/15 EMS 133 Medical Emergencies: 10/22, 10/29, 11/5, 11/12 EMS 135 Trauma Emergencies: 11/19, 11/26, 12/3 EMS 171 Clinical Internship: Individual schedule throughout the semester EMS 130 IV Therapy (Required for any student who has not previously completed) Online begins 8/20/18 with Lab days on Monday and Wednesday nights 9/10 through 9/19. Admission Requirements for the AEMT Program: In order to even be considered for acceptance into the AEMT Program at Aims Community College you must meet the following conditions: Must hold a current State of Colorado EMT Basic or must be able to obtain prior to clinical attendance. Must hold a current American Heart Association - Healthcare Provider CPR Certification. Must have Evidence of Course Completion of an Intravenous Therapy course or take EMS 130 during the same semester. Interview Requirements: The student will also be required to complete the following on the day of interviews for the AEMT Program. EMT - Basic Entrance Exam. Oral Interviews consisting of: (Medical Scenario, Trauma Scenario, an Ethical Scenario & Resume Review) Aims Community College: AEMT Program Application - 2017 to 2018 Cycle Page 3 of 12

Aims Community College: AEMT Program - Application / Documentation for Admission Full Legal Name: Maiden / Previous Name: Last First Middle Permanent Address: E-mail Address: Home Address City State Zip Primary Telephone: This is a: Cell Phone: Pager Secondary Telephone: This is a: Cell Phone: Pager Birth Date: / / Best Time To Call: Month Date Year Complete the following information and provide the required documentation: Type Of School High School or G.E.D. (Required) Name & Address Of School Years Completed Degree Received Major Did You Graduate College (Undergraduate) College (Graduate) EMT-B (Required) I.V. Therapy Course (If available) CPR Certification (Required) ACCUPLACER Scores: Other (Specify): Attach two letters of recommendation from colleagues, employers, or instructors who are familiar with you as an EMT with this application. Aims Community College: AEMT Program Application - 2017 to 2018 Cycle Page 4 of 12

Admission Essay: In approximately 200 words tell us about your EMS experience and what you hope to achieve through the AEMT Program. Aims Community College: AEMT Program Application - 2017 to 2018 Cycle Page 5 of 12

Required Documentation: Must Be Submitted Along With The Application: Academic Records: (High School Diploma or GED minimum requirement) Current State of Colorado EMT - B. (Must be obtained prior to attending clinical shifts and remain current throughout course) Current American Heart Association - Health Care Provider CPR certification. (Must remain current throughout course) Evidence of Course Completion for an Intravenous Therapy class and other applicable certifications. Current resume documenting your work experience. Admission essay. (Provided in this application packet) Two letters of recommendation. Completed application. Completed Background Check: Must Be Completed By The First Day of Class: Successful completion of the Aims Community College Background Check is required for admission into the AEMT Program; therefore it is required by the first day of class so that we can ensure that you are eligible to participate and attend the various clinical and internship sites included in this AEMT Program. Students will be dismissed from the course if background checks are not completed by the first day of class. Students will be emailed a link to begin background checks after acceptance into the program. After Aims Community College EMS Department has received all of your required documents, you will be contacted to schedule an interview and entrance exam. Aims Community College: AEMT Program Application - 2017 to 2018 Cycle Page 6 of 12

Background and Disqualifying Offenses: The purpose of a Background Investigation is to maintain a safe and productive educational environment. Students who refuse to comply with the Background Investigation process will be denied admission to any Aims Community College Allied Health Sciences or Public Services Program. NOTE: All students are considered provisionally accepted until all elements pertaining to their Background Investigations are received and reviewed by the college. For most programs, these elements include a Criminal Background Check & Drug Screen. Disqualifying Criminal Offenses: Any conviction, plea of guilty or no contest, or deferred prosecution of the following criminal offenses (Felony or Misdemeanor) that appears on any part of a Criminal Background Check at the time an application to a program is submitted will disqualify an applicant admission to their program and may also disqualify a student from admission to a clinical facility. Students who have successfully completed the terms of a deferred adjudication will not be disqualified from their program. Students who have a disposition of "dismissed after successful completion," regardless of the crime, will not be disqualified from the program. An applicant will be disqualified from an Allied Health and Human Services or Public Services Program based on the following guidelines: Any violent felony convictions of homicide (no time limit). Any registered sex offender (no time limit). Crimes of violence (assault, sexual offenses, arson, kidnapping, any crime against an at risk adult or juvenile, etc.), as defined in section 18-1.3-406-C.R.S in the 10 years immediately preceding the submittal of application and / or prior to. Any offense involving unlawful sexual behavior in the 10 years immediately preceding submittal of application and / or prior to starting class. Any crime, the underlying basis of which has been found by the court on the record to include an act of domestic violence, as defined in section 18-6-800.3 C.R.S. in the 7 years immediately preceding the submittal of application and / or prior to starting class. Any crime of child abuse, as defined in section 18-6-401 C.R.S. in the 7 years immediately preceding the submittal of application and / or prior to starting class. Any crime related to the sale, possession, distribution or transfer of narcotics or controlled substances the 7 years immediately preceding the submittal of application and / or prior to starting class. Any crimes related to section 18-18-426 C.R.S (Paraphernalia) are not considered disqualifying offenses. Non-negative drug screen. Students utilizing medical marijuana under sections 18-18-406.3 and 25-1.5-106 C.R.S. are not excluded from this requirement. For all programs, the time period for this disqualification is 6 months. Once the 6 month exclusion has expired, students will be required to obtain a second drug screen. Any felony theft crimes in the 7 years immediately preceding the submittal of application and / or prior to starting class. Any misdemeanor theft crimes in the 5 yrs immediately preceding the submittal of application & / or prior to starting class. Misdemeanor or felony crimes of moral turpitude as defined section 18-7-101 C.R.S. in the 7 years immediately preceding the submittal of application, which include but are not limited to prostitution, sexual exploitation of a minor and criminal invasion of privacy. Any offense in any state other than Colorado, the elements of which are substantially similar to the elements of any of the above offenses. Any offence that would qualify as a disqualifying offence, which is still pending in the courts (without official legal disposition) at the submittal of application and / or prior to starting class. More than one (1) DUI in the 7 years immediately preceding the submittal of application and / or prior to starting class. Any student included on the HHS / OIG List of Excluded Individual / Entities or GSA List of Parties Excluded from Federal Programs. Any student included on the US Treasury, Office of Foreign Assets Control (OFAC), List of Specially Designated Nationals. Aims Community College: AEMT Program Application - 2017 to 2018 Cycle Page 7 of 12

Background and Disqualifying Offenses Continued: If the Background Investigation reveals information that could be relevant to the application, the designated individual or committee within Aims Community College May request additional information from the applicant. The potential Disqualifying Offense shall be reviewed on a case by case basis. Aims Community College reserves the right to remove a student from any Allied Health Sciences or Public Services Program of study in the event a Disqualifying Offense appears on any of the above mentioned checks. Students may be subject to random or For Cause drug screens. Refusal to comply with such a request will result in immediate removal from the Allied Health Sciences or Public Services Program. Annual checks for HHs / OIG List of Excluded Individuals / Entities and GSA List of Parties Excluded from Federal Programs may be required to meet requirements of certain clinical facilities. NOTE: Clinical facilities may also choose to require additional background checks, drug screens and / or fingerprinting, and may disqualify students from participating at a clinical site based on individual facility policies independent of any action by Aims Community College; and that a disqualifying background check from a clinical agency may render me ineligible to continue in an Allied Health Sciences or Public Services Program. Any additional drug screening may be at additional cost to the student. All Background Investigations will be processed under the Fair Credit Reporting Act, and Aims Community College has enacted a "red flag procedure" as required by November 1, 2008. 16 CFR 681. The applicable applicant / employee will be notified and informed in the event of an unacceptable background report. By signing the form below, I accept the responsibility for understanding the above content. Printed Name Signature: Aims ID or Date of Birth Date: Aims Community College: AEMT Program Application - 2017 to 2018 Cycle Page 8 of 12

Aims Community College: Consent and Release - Background Investigation As part of the application process for admission to the AEMT Program at Aims Community College ("the school") and ("School"), I understand that the School and or its agents will require a Background Investigation of my personal information via a Criminal Background Check and Drug Screen, which may include, but is not limited to: Statewide Criminal Record Search (County Criminal Record Search in the absence of Statewide Criminal Record Search), Federal Criminal Search, Social Security Trace, Nationwide Sex Offender Registry, Office of Inspector General (OIG), General Services Administration (GSA), Office of Foreign Assets Control (OFAC) / Specially Designated Nations List (SDN), Employment Verification, and a 10 panel Drug Screen. I understand that the Background Investigation will be used by the School to determine my eligibility for program admission and to participate in clinical activities in the School's Allied Health and Human Services or Public Service Programs. I also understand that I may be asked to provide additional information and that failure to provide information as requested will be considered just cause for denial of admission to the School. I hereby authorize, without reservation, the Background Investigation and the release of information and records related thereto by HireRite to the School. I also authorize the School to release the results of the Background Investigation (and any information and records related thereto for purposes related to my application for admission to the School) to any Clinical Facility, if required by them, at any time while I am enrolled for the purposes of my participation in the clinical program. I hereby release, discharge and agree to hold harmless HireRite and the School and all of their respective employees, officers, directors, agents and assigns from and against any claims for losses or damages, and liabilities, actions or causes of action or any other charges or complaints arising out of or related to the Background Investigation or the release of information and records relating thereto. I am aware that Clinical facilities may also choose to require an additional Background Investigation and may disqualify students from participating at a clinical site based on individual facility policies. I am aware that a disqualifying Background Investigation from a clinical agency may render me ineligible to continue in an Allied Health or Public Service Program. I am also aware that all Background Investigations will be processed under the Fair Credit Reporting Act, and Aims Community College has enacted a "red flag procedure" as required by November 1, 2008. 16 CFR 681. I certify that any information provided as for the Background Investigation application is correct to the best of my knowledge, and I acknowledge that any false statements provided will be considered just cause for denial of admission to the School. I also understand that upon request, HireRite will provide me with a copy of my report and my rights under the Fair Credit Reporting Act. Printed Name Signature: Aims ID or Date of Birth Date: Aims Community College: AEMT Program Application - 2017 to 2018 Cycle Page 9 of 12

Aims Community College: Consent and Release - Required Drug Screening A drug screening was required as a part of the admissions process or as a condition of continued enrollment. Some Aims Community College - affiliated clinical facilities may also require disclosure of a student's drug screening results prior to permitting the student to participate in the educational program at the facility. A favorable review of this information by Aims Community College as a condition of admission and continued enrollment is not binding upon a clinical facility. A clinical facility may refuse to permit a student participate in the clinical practicum at the facility if drug screening results are not provided, or if upon review of a student's drug screening, it determines the student is disqualified. Please complete the following authorization. I authorize Aims Community College to release drug screenings in its possession to affiliated clinical facilities. The purpose of releasing this information is to permit the clinical facility to verify my qualifications to participate in the educational program offered at that facility. I further authorize Aims Community College permission to access and release certain personal identifying information, such as identification numbers, for the purposes stated herein. I hereby release, discharge and agree to hold harmless HireRite and Aims Community College and all of their respective employees, officers, directors, agents and assigns from and against any claims for losses or damages, and liability, actions or causes of action or any other charges or complaints arising out of or related to the drug testing or the release of information and records relating thereto. I am aware that clinical facilities may also choose to require additional drug screens and may disqualify students from participating at a clinical site based on individual facility policies. I am aware that a positive drug screen may render me ineligible to continue in an Allied Health or Public Service program. I am also aware that all drug screens will be processed under the Fair Credit Reporting Act, and Aims Community College has enacted a "red flag procedure" as required by November 1, 2008: 16 CFR 681. I understand that upon request, HireRite will provide me with a copy of my drug screen and my rights under the Fair Credit Reporting Act. Printed Name Signature: Aims ID or Date of Birth Date: Aims Community College: AEMT Program Application - 2017 to 2018 Cycle Page 10 of 12

Immunization Requirements: Must Be Completed By The First Day of Class: All of the immunizations listed below are required by the Aims Community College AEMT Program in order for the student to attend clinical locations during the program. The AEMT Program Clinical Staff will begin establishing clinical sites very early into the program, therefore all immunization records must be completed by the first day of class. Students will be dismissed from the course if immunization records are not received by the first day of class. Additionally, students may be required to receive additional immunizations other than those listed below throughout the program at the request of clinical locations. Students will be responsible for that cost. Remember: All immunization records must be official, meaning they must be signed / stamped and dated by the person giving the immunization. Records must have the name of the facility where immunizations were administered. Two (2) Negative Tuberculosis TST / PPD / TB Screening Tests: Also known as a "2 step" or a negative chest x / ray report if you have had a previous positive TB test. TB tests must be less than 9 months old and last throughout the semester the student is enrolled in. Remember: A two (2) step TB test means that you will get the TB test injected and read 48 hours later. A week later you will need to get another one injected and read again. Clinical sites require two (2) negative TB tests, no exceptions. Remember: Official documentation must show the dates when the student was injected and read with a negative reading, along with a signature or stamp with the location of the facility that provided the TB tests. MMR: Laboratory evidence of immunity (titer) to Rubella, Rubeola, and Mumps. 3 positive titers or: Documented evidence of 2 vaccinations. Remember that MMR vaccinations have a period of 30 days between the 2. Varicella: Laboratory evidence of immunity (titer) to Varicella (Chicken Pox). 1 positive titer or: Documented evidence of 2 vaccinations. Remember that Varicella vaccinations have a period of 30 days between the 2. Hepatitis B: Laboratory evidence of immunity (titer) to Hepatitis B. Positive titer or: Documented evidence of completed Hepatitis B vaccinations series (3). A signed waiver will be accepted in place of immunization only if you are current and in progress of completion. Remember that Hepatitis B has a period of 30 days between the first 2 and 6 months for the 3rd. Tetanus: Vaccine must be less than 10 years old. (DTAP, TDAP, etc.) Flu Shot: Signed paper verification from a doctor's office or clinic. Pick up flu shot form from Stacey or on the online orientation website at http://www.aims.edu/academics/ems. Health Insurance: Private health insurance coverage is required by some of the clinical sites that the student may have to attend; therefore private health insurance coverage must be in place by the first day of class and must be maintained throughout the entire program. Aims Community College: AEMT Program Application - 2017 to 2018 Cycle Page 11 of 12

Advising Acknowledgement Form: Clinical or Internship Expectations The AEMT Program will include clinical rotations as well as internship rotations as a part of the certificate program. Those clinicals and internships will be offered in the same semester as the lecture / labs and some will require that the clinical / internship is completed the same semester. The clinical / internship component for the AEMT Program requires that students have the required pre-requisites background investigation, drug screening, and shot records completed by established due dates. Students that do not have those pre-requisites completed by the due date will be dropped from the clinical / internship class. This action may result in the student having to repeat the certificate. Pre-requisite requirements can be found at: http://www.aims.edu/academics/ems/orientations/aemt/index.php Students enrolled in the clinical / internship portion of one of the above certificate programs will be notified of the dates, times, and location of their clinical / internship. Students do not get to select the schedule or the location of their clinical / internship. Students must be available for the times selected for their clinical / internship as designated by the clinical / internship instructor anytime during the dates scheduled for the clinical / internship during the semester. Students should also anticipate having to travel up to an 80+ mile radius from Greeley to attend a clinical site. Students that do not attend the clinical / internship on the times and dates as assigned will be dropped from class or receive an "F" grade. Delaying a clinical / internship may result in the student having to retake the lecture / lab components of the certificate in order to qualify to complete the clinical / internship component of the certificate. Printed Name Signature: Aims ID or Date of Birth Date: Aims Community College: AEMT Program Application - 2017 to 2018 Cycle Page 12 of 12