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EMORY EMS EMT/AEMT COURSE APPLICATION 2020-2021

Dear EMT/AEMT Course Applicant,

Emory Emergency Medical Services (EEMS) is a professional EMS agency that provides vital medical services, education, and outreach to Emory University and the surrounding community. EEMS was founded in 1992 as the first collegiate EMS agency in the state of Georgia and is an award-winning and nationally recognized collegiate EMS organization.

In the EMT/AEMT Course, students learn life-saving patient care skills through both didactic and clinical experience. In accordance with Emory's changing learning environment, this year we will use a combination of both virtual and in-person learning for the didactic portions of the course. Hands-on ("psychomotor") learning is imperative in the medical field and will continue to be a part of all EMS education programs. In order to protect our students and instructors in this type of environment, we will meet established safety and health guidelines and standards. In addition, students will complete EMS and hospital based clinical hours, as required to meet the standards set forth by the state of Georgia for EMS inital education programs. EMS is an integral part of the healthcare system, and we must continue to educate the next generation of providers.

While this course requires considerable extracurricular work, it can be one of the most rewarding activities during your time at Emory. There is a separate tuition for the course, but it is a fraction of what other local programs cost. Contact us with questions regarding tuition and payment structure.

The purpose of our EMT/AEMT Course is to staff Emory EMS with highly trained, licensed Advanced EMTs. The course is approximately 1 year in length, beginning in August and following the undergraduate academic calendar. Upon successful course completion, graduates must apply for an EMS provider license in the state of Georgia and volunteer for at least one academic year as an active member of Emory EMS.

**Entry into this course is a minimum two year commitment.**

For more information, visit eems.emory.edu.

Thank you for your time,

The Emory EMS Command Staff

EMORY EMS EMT/AEMT COURSE APPLICATION 2020-2021

APPLICATION must be RECEIVED by AUGUST 10, 2020

ALL PAGES/FIELDS ARE REQUIRED. FALIURE TO SUBMIT A COMPLETED APPLICATION WITH ALL REQUESTED DOCUMENTS

WILL RESULT IN YOUR APPLICATION BEING REMOVED FROM CONSIDERATION.

Instructions: Complete this application to the best of your knowledge. All fields should be typed. You may submit your completed application by mail, drop off/delivery, or email.

Prior to submitting, ensure that the pages of your application are properly filled out and initialed/signed where required.

Mail or bring completed application to our headquarters: Emory EMS

Attn: 2020 EMT/AEMT Course Application 1784 N. Decatur Rd., Suite G-01, Atlanta, GA 30322

Check each of the following, indicating that all requested documents are included.Completed Application

Copy of High School Diploma or Equivalent

Copy of Immunization Records

Resume/CV. Maximum 1 page resume or CV which includes any other extracurricular activities, leadership positions, volunteer work, or honors/awards you would like to tell us about.

Letter of Recommendation (Optional)

For questions, email eems.education@emory.edu or call (404) 727-0180

Or email the completed application to:eems.education@emory.edu

And use subject: 2020 EMT/AEMT Course Application

I do, by my signature, acknowledge that I have read the “Dear EMT/AEMT Course Applicant” letter (above) and understand that Emory EMS is a minimum 2 year commitment. My signature certifies that the information in this application is true and correct to the best of my knowledge. I understand that willfully supplying false information is sufficient cause for rejection of my application or removal from the Course.

Signature Date

Parent/Guardian Signature (if under 18) Date

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APPLICANT INFORMATION

Name FIRST MIDDLE

State Zip Code

Cell Phone ( ) -

Emory Student/Employee ID#

Social Security Number

Parent/Guardian Name (if under 18)

Permanent Address

City

Home Phone ( ) -

Emory P.O. Box

Date of Birth

Primary E-mail Address

Yes No - Are you alcohol or drug dependent?

Yes No - Have you ever been convicted in any court of a felony or other criminal offense, or do you have any criminal offense pending? (If yes, attach an explanation)

Fill in the blanks AND attach LEGIBLE documentation of ALL of the following: Hepatitis B (First dose required)

Dose 1 Date___________ (required) Dose 2 Date___________ Dose 3 Date___________

MMR: Measles/Mumps/Rubella (Both doses required) Dose 1 Date___________ Dose 2 Date___________

Chicken Pox (Documentation Required) Do you have a history of this disease? Yes No If Yes: Date(Month/Year) ___________ If No: Known serologic immunity? Yes No

or Vaccine received Dose 1 Date___________ Dose 2 Date___________

Yes No - Are you an Emory undergraduate? If yes, choose your standing for the 2020-2021 academic year: If no, how are you affiliated with Emory University? List all current healthcare certifications or licenses that you have, including cert/license # & state/location:

LAST

How did you hear about Emory EMS and/or the Emory EMT/AEMT Course?

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Please take time and care in answering the questions below. Character limits are strictly enforced.

The purpose of the EMT/AEMT course is to prepare program graduates to volunteer for Emory EMS. Why do you want to be an Emory AEMT, and how will you contribute to the organization? (2500 characters) Enter response here

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The EMT/AEMT course is analogous to having a job and therefore requires a considerable amount of time in addition to your other Emory commitments. Describe a time in your life when you had too many things to do and you were required to prioritize your tasks. (2500 characters) Enter response here

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Describe a significant mistake that you made recently in your life. Did you resolve the situation? Explain. (2500 characters) Enter response here

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Give an example of a time when you had to figure out how to get along with someone that was difficult to work with (can be professional, academic, athletic, etc.). Explain why the person was difficult to work with. How did you overcome your differences and work as a team? (2500 characters)Enter response here

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Use the following link to access the NHTSA National EMS Scope of Practice Model, and review p. 25-26, "Advanced Emergency Medical Technician": https://www.ems.gov/education/EMSScope.pdf

Considering the information contained in the Scope of Practice document, what scares you the most about becoming an Advanced EMT? When you think about what it will be like to be an AEMT, what are you most looking forward to? (1500 characters)

Enter response here

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Write about something you are passionate about. (1500 characters)

Enter response here