Ed Bak ProgramManager, Emergency MedicalTechnology 2900 Community College Ave-MHCS 126H Cleveland, OH

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1 Dear Prspective Emergency Medical Technlgy Student, Thank yu fr yur interest in the Emergency Medical Technlgy (EMT) Prgram at Cuyahga Cmmunity Cllege Where Futures Begin. The prgram is accredited by the State f Ohi, Divisin f EMS, and Accreditatin 312 t ffer Emergency Medical Respnder, EMT, Advanced EMT, and Paramedic certificatin curses. It als prvides cntinuing educatin fr all levels f EMT. Our prgram fcuses n student success. We are pleased t help yu design a plan fr yur success here at Tri- C, as well as in the EMS career. We wrk clsely with the Fire Academy staff t assist thse seeking a career in firefighting attain their gals. The cllege accepts applicatins n a cntinual basis fr the EMT prgram. Call the EMT ffice fr infrmatin regarding apprval t enter the prgram. Submitting yur applicatin early better enables us t assist yu in yur plan t achieve certificatin. A backgrund check frm the cllege apprved vendr is required in rder t give departmental apprval fr certificatin curses. The prgram ffers EMT certificatin classes every semester. The paramedic certificate prgram begins each fall and spring semester. Questins pertaining t the EMT prgram at the cllege may be directed t the EMT ffice at We wish yu success in reaching yur educatinal gals. Sincerely, Ed Bak PrgramManager, Emergency MedicalTechnlgy 2900 Cmmunity Cllege Ave-MHCS 126H Cleveland, OH Edward.Bak@tri-c.edu Encl: Health Careers Applicatin EMTPrgram Applicatin

2 Emergency Medical Technlgy Emergency Medical Technlgy Prgram The Emergency Medical Technlgy Prgram The Emergency Medical Technlgy department at Tri-C rutinely ffers: Shrt term certificate fr EMT Basic. Shrt term certificate fr Paramedic. Assciate f Applied Science (AAS) in EMT. Assciate f Applied Science (AAS) in Fire-Emergency Medical Services Credits earned in the EMT and Paramedic ST certificates are applied tward the AAS in EMT. The prgram can be accmplished in a traditinal cllege degree sequence, r students may take the EMT and Paramedic certificate curses, and then cmplete the assciate degree requirements after achieving state certificatin and pursuingemplyment. Admissin t the Prgram Disqualificatin Ohi Administrative Cde precludes admissin f students t EMT certificatin curses with a felny n their recrd. The State f Ohi EMS Bard individually reviews the applicatins fr certificatin f thse with misdemeanr cnvictins after a backgrund investigatin by the divisin staff. They may chse nt t certify these individuals. These applicatins are handled n a case-by-case basis, after curse cmpletin. There is n mechanism t prereview the circumstance t determine certificatin eligibility. Students wh are charged r cnvicted f a felny r misdemeanr invlving mral turpitude while in the prgram may be suspended r dismissed frm the prgram. The applicatin prcess: Cllege applicatin English and Math assessments EMT/Health Careers applicatin Submit applicatin materials t Submit a TRI-C General Applicatin fr Admissin r Readmissin, if yu have nt applied t the cllege in the past. Online admissin applicatin is available athttp:// Cmplete TRI-C English and Math assessment tests. Sample tests and infrmatin abut the assessment centers available at Cmplete the Health Careers Prgram Applicatin, and frm the EMT Prgram applicatin, the Student Infrmatin, and Self Evaluatin Frms. The Health Infrmatin frm can be frwarded later. Additinal EMT infrmatin availableathttp:// Health Careers Enrllment Center Cuyahga Cmmunity Cllege 2900 Cmmunity Cllege Ave-MHCS 126 Cleveland, OH State f Ohi EMS Accreditatin #312 Rev. June 1,

3 Emergency Medical Technlgy EMT Certificatin Prgram and Shrt Term Academic Certificate EMT Certificatin Prgram and Shrt Term Academic Certificate Prgram Descriptin The EMT Certificatin Prgram (EMT 1302 and EMT 130L) at Cuyahga Cmmunity Cllege is the entry level training fr the prfessinal pre-hspital care prvider. Students that successfully cmplete the prgram are eligible t take the Natinal Registry f EMTs (Emergency Medical Technician Examinatin), which is required fr State f Ohi EMT Certificatin. State f Ohi EMT Certificatin is required by state rule t cntinue n t EMT- Intermediate r Paramedic. The EMT Shrt Term Certificate, an academic credential awarded by Tri-C, als includes EMT 1401 Anatmy & Physilgy fr Paramedics. This curse is required 1 t advance t the Paramedic prgram. Requirements fr admissin Minimum age GeneralAdmissin t Tri-C English and Math Backgrund Check Eighteen (18) years f age r seventeen (17) years f age and a high schlsenir. Cmplete general requirements fr admissin - described n the previus page Eligibility fr ENG 0990 and MATH 0955 n placement exams Cmplete required Health Careers apprved backgrund check. Additinal infrmatin abut backgrund check available at Directins fr the backgrund check are available at the link at the bttm f the page. Once these requirements are met, cntact the EMT Prgram Manager t secure departmental apprval t register. Requirements t attend field experience The EMT curse includes lecture, lab, and field experience. The fllwing items are required t schedule and participate in the field experience cmpnent f the curse (EMT 130L): TB testing and vaccinatins Physical Exam Liability Insurance Health Insurance CPR - Submit prf f vaccinatins and TB test results befre the first class sessin (Physical Exam and Immunizatin Dcumentatin Frm). Dcumentatin frm a physician fr fitness t participate in the prgram befre first class sessin (Physical Exam and Immunizatin Dcumentatin Frm). Students are assessed the fee thrugh the cllege Enrllment Center when they register fr EMT 130L. Prvide prf f persnal healthcare insurance. If nt cvered, ne surce fr student health insuranceis This is nt the nly acceptable insurance. Successful cmpletin f the Basic Life Supprt fr the Health Care Prvider cmpnent f the curse. 1 BIO 2331 and BIO 2341, Anatmy & Physilgy I & 2 may be substituted fr this curse. State f Ohi EMS Accreditatin #312 Rev. June 1,

4 Emergency Medical Technlgy Paramedic Certificatin Prgram and Shrt Term Academic Certificate Anticipated curse expenses fr : Estimated Csts fr EMT Basic Certificatin(EMT1302 and EMT130L) Tuitin-EMT 1302 EMT-Basic& EMT 130LPractical Lab-7semester/hurs. In Cunty In State Out f State 1, Backgrund check, estimate, additinal cst fr ut f state residency Textbks, unifrm, medical equipment Clinical unifrm shirt Student Medical Liability Insurance Subttal EMT Certificatin Curses 1, , , Estimated Cst fr EMT 1401 Anatmy & Physilgy fr Paramedics Tuitin- EMT Texts, instructinal materials Subttal Paramedic Success , Ttal EMT Shrt Term Certificate (Includes prerequisites fr Paramedic) 1, , , Paramedic Certificatin Prgram and Shrt Term Academic Certificate Prgram Descriptin This prgram is significantly revised effective Fall The paramedic certificate prgram requires successful cmpletin f the EMT ST Certificate prgram, including EMT 1401 Anatmy & Physilgy fr Paramedics. This serves as the state required anatmy and physilgy prerequisite fr Paramedic. Students wh have cmpleted the science curses, BIO 2331 and BIO 2341 Anatmy and Physilgy I & II may substitute these fr the EMT 1401 Anatmy & Physilgy fr Paramedics curse. Students wh cmpleted EMT training thrugh anther institutin will need t take EMT 1401 r BIO 2331 and BIO 2341, r have apprval fr equivalent curses cmpleted elsewhere, t meet this requirement. Students then cntinue int EMT 2330 thrugh EMT 2370 Paramedic Thery 1 thrugh 5 curses. The ttal paramedic hurs required fr certificatin exceeds 900 cntact hurs. Students wh successfully cmplete the certificate prgram are eligible fr Natinal Registry f EMT s Paramedic testing. This test is used by the State f Ohi as its certificatin examinatin. Requirements fr admissin and retentin Minimum requirements fr admissin int the Paramedic Certificate are listed belw. GeneralAdmissin t Tri-C EMT Certificatin English and Math assessments Gd standing in prgram Backgrund Check Cmplete general requirements fr admissin - described n page 3. Prvide evidence f certificatin as an EMT in the State f Ohi t cntinue int EMT 2330 Paramedic Thery I. Eligibility fr ENG 1010 and MATH 0955 n placement exams t cntinue int EMT 2330 Paramedic Thery I Maintain a C r higher grade in EMT 1401 and EMT If new t the prgram, r returning mre than tw years after beginning EMT, cmplete required Health Careers apprved backgrund check. Additinalinfrmatin abut backgrund check available at Once these requirements are met, cntact the EMT Prgram Manager t secure departmental apprval t register. State f Ohi EMS Accreditatin #312 Rev. June 1,

5 Emergency Medical Technlgy Assciate f Applied Science in EMT Requirements t attend clinical/field experience TB testing and vaccinatins Physical Exam Liability Insurance Health Insurance CPR EMTCertificatin Anticipated curse expenses fr *: - Submit prf f vaccinatins and TB test results befre the first class sessin (Physical Exam and Immunizatin Dcumentatin Frm). Dcumentatin frm a physician fr fitness t participate in the prgram befre first class sessin (Physical Exam and Immunizatin Dcumentatin Frm). Students are assessed the fee thrugh the cllege s Enrllment Center when they register fr EMT Prvide prf f persnal healthcare insurance. If nt cvered, ne surce fr s t u d e n t h e a l t h insuranceis This is nt the nly acceptable insurance. Prvide evidence f current CPR credentials fr the Health Care Prvider. Prvide evidence f State f Ohi EMT certificatin. Estimated Csts fr Prgram In Cunty In State Out f State Tuitin - Paramedic Certificate 29 semester/hurs 3, , , Backgrund check, estimate, additinal cst fr ut f state residency Textbks, unifrm, medical equipment Clinical unifrm shirt Student Medical Liability Insurance Ttal 3, , , *Due t changes in curriculum and ptential adptin f new learning materials, the textbk cst estimates are very preliminary. Assciate f Applied Science in EMT Prgram Descriptin The Assciate f Applied Science in Emergency Medical Technlgy: Includes the EMT Basic and Paramedic certificate curses. Transfers t fur-year clleges t cmplete a Bachelr s degree. May be cmpleted in a traditinal manner, r the student may cmplete the certificate curses then return t cmplete the degree requirements. Is designed t build the academic skills and backgrund knwledge t prmte student success. Prvides cmmn grund with ther health prfessinals. Tri-C Fire Academy credits include AAS in EMT elective. y.aspx. Cnfers additinal academic credential, imprtant fr thse seeking cmpetitive psitins. Details f the AAS in EMT are available at State f Ohi EMS Accreditatin #312 Rev. June 1,

6 HEALTH CAREERS PROGRAM APPLICATION Received: Please Print r Type All Infrmatin Prgram f Applicatin Full Legal Name Last First Middle Frmer, if applicable Address: Apt # Telephne: ( ) City: State: Zip cde: Cunty: Student Number: (This can als be yur scial security number) Address: Are yu nw r have yu ever been enrlled at Cuyahga Cmmunity Cllege: Yes: Separate fficial cllege transcripts fr each cllege and university attended must be submitted t the Admissins Office alng with yur applicatin t the cllege by the applicant at least 8 weeks prir t submissin f health career applicatin packet. If yu are transferring credits frm anther cllege r university it is necessary t btain a secnd fficial cpy f yur transcript which must be included in the Health Career Applicatin Packet. Cmplete the fllwing blanks if yu have attended any ther cllege, university r ther pst high schl prgrams. (List in rder f attendance, mst recent first.) N: Name f Cllege/University City and State Frm Mnth Year T Mnth Year Military Service Veteran: Have yu ever been cnvicted f a felny: Yes: N: Misdemeanr: Cmpletin f this frm and minimum prgram requirements des nt cnstitute admissin t the prgram. Applicants will be ntified by letter when they are accepted int the prgram. Cuyahga Cmmunity Cllege is cmmitted t cntinuing affirmative actin and equal pprtunities f access t emplyment and educatin and thus des nt discriminate against current r ptential emplyees r students n the basis f race, clr, religin, sexual rientatin, natinal rigin r ancestry, age, disability, sex, military status, r status as a veteran. It is als the intent f the Cllege t cmply with apprpriate federal and state laws, rules and regulatins and t give special attentin t increasing the participatin f minrities, wmen, persns with a disability(s), and disabled veterans in all levels f the Cllege. It is als the intent f the Cllege t ensure that its envirnment is free frm harassment r intimidatin f any kind. "I certify that the infrmatin prvided n this applicatin is cmplete and accurate in every respect. I understand that falsifying any f this applicatin may result in cancellatin f admissin." Signature f Applicant (D Nt Print): Revised 6/2011 Date:

7 Health Career Prgram Applicatin (Please submit a separate applicatin fr each prgram) PLEASE PLACE AN X IN FRONT OF THE PROGRAM FOR WHICH YOU ARE APPLYING (ONLY ONE PROGRAM PER APPLICATION) _ Cllege Wide Emergency Medical Technlgy East Metr West Westshre Day Evening Fall Spring Summer Basic Certificate EMT Paramedic Certificate f Prficiency EMT - Assciate Degree Fire-EMS - Assciate Degree Health Infrmatin Management Metr Day Evening Sprts and Exercise Studies East Metr West Medical Assisting Certificate (1 Year) East Metr West Westshre Medical Assisting Assciate Degree East Metr West Westshre _ Eastern Campus Based Prgrams Pharmacy Technlgy Day Evening Certificate (1 Year) AAS Degree (2 Years) _ Metrplitan Campus Based Prgrams Cancer Registrar Pst Degree Certificate (1 Year) Health Unit Crdinatr Human Services Occupatinal Therapy Assistant Optical Technlgy Dental Office Manager Scial Wrker Asst _ Drug Cunseling Ophthalmic Assisting Certificate Dental Hygiene Labratry Phlebtmy Certificate Physical Therapist Assisting Dietetic Technlgy Dietetic Manager Certificate General Nutritin Certificate (1 Year) Medical Billing Specialist Certificate (1 Year) Medical Labratry Technlgy (2 Years) Sterile P r ce s s i ng a n d Distributin (1 Year) Surgical Technlgy _ Western Campus Based Prgrams Diagnstic Medical Sngraphy (Select Optin Belw) Abdminal/Ob/Gyn Optin Echcardigraphy Vascular Electrneurdiagnstics Mammgraphy Nuclear Medicine Plysmngraphy Radigraphy Respiratry Care Veterinary Technlgy Submit T: Health Careers Enrllment Center, 2900 Cmmunity Cllege Ave Cleveland, OH 44115

8 Nursing and Allied Healthcare Career Prgrams Backgrund Check & Cnvictin f Crime Acknwledgement I understand and acknwledge that Cuyahga Cmmunity Cllege District (the Cllege ) may develp r btain ne r mre criminal backgrund checks ( CBC ) pertaining t me The CBC may be used fr evaluatin f my eligibility fr ne r mre limited-entry prgrams f the Cllege, and eligibility fr ne r mre clinical/practicum/internship training requirements with third party rganizatins. I understand and acknwledge that the CBC may cntain infrmatin cncerning my criminal backgrund. In all cases, all expenses assciated with the CBC are t be my respnsibility. If the results f the CBC are nt deemed acceptable by the Cllege, r if infrmatin received indicates that I have prvided false r misleading statements, have mitted required infrmatin, r in any way am unable t meet the requirements fr cmpletin f the prgram, my admissin may be denied r rescinded, and/r I may be disciplined r dismissed. I further understand and acknwledge that if, while I am a student, I am cnvicted f a crime f any type, ther than a minr traffic vilatin, I must reprt the ffense t the applicable prgram manager in writing within thirty (30) days f cnvictin (cnvictin includes plea arrangements, guilty pleas, pleas f n cntest, findings f guilt, etc.). I understand and acknwledge that these backgrund checks will be btained by the vendr chsen and specified by the Cllege. The current vendr fr this service is CastleBranch with crprate headquarters lcated at 1844 Sir Tyler Drive, Wilmingtn, NC 28405, (Telephne, The vendr is subject t change at any time. Backgrund checks btained frm a vendr ther than the vendr chsen and specified by the Cllege will nt be accepted. I acknwledge and understand that I may nt be admitted t a clinical setting, be permitted t test fr r be granted licensure r accreditatin if I have been r in the future am cnvicted f a crime. I acknwledge and understand that admittance t a limited-entry and/r cmpletin f a prgram in n way guarantees that I will receive licensure, be permitted t practice and/r btain future emplyment. I understand that I am financially respnsible fr all csts incurred as a student. Student Signature (Sign) Date Student Name (Print) S-Number Effective Rev Healthcare Educatin Initiatives Frm N. HEI 1 K:\Academic & Student Affairs (ASA)\Medical Educatin Prgrams\Standardized Student Dcuments

9 Student Infrmatin Frm Last Name: First: Middle: Frmer, If applicable: Student Number: State f Ohi EMT/Fire Certificatin Number Date f Birth: High Schl Diplma r GED: Y_ N Please respnd t the fllwing questins t determine qualificatin fr certificatin under OAC A: 5. Are yu at least 18 years ld r 17 years ld and a high schl senir (r high schl graduate)? 6a-e, 8. Have yu ever been cnvicted f, pled guilty t, had a judicial finding f guilt fr r had a judicial finding f eligibility fr treatment/interventins in lieu f cnvictin fr; r are yu currently under indictment fr any f the fllwing: any felny; a misdemeanr cmmitted in the curse f practice; a misdemeanr invlving mral turpitude; a vilatin f any federal, state, cunty, r municipal narctics law r cntrlled substance law; an act cmmitted in anther state, that, if cmmitted in Ohi wuld cnstitute a vilatin set frth in (a)(6) f the Ohi Administrative Cde? 7. Have yu ever been adjudicated mentally incmpetent by a curt f law? Yes N 9. D yu currently engage in the illegal use r illegal acquisitin f cntrlled substances, alchl, r ther habit frming drugs r chemical substances while n duty as a first respnder r EMT? 10. Have yu ever cmmitted fraud r material deceptin in applying fr, r btaining a certificate t practice under Chap 4765 f the Revised Cde? 11. Have yu been cnvicted, in this state r anther state, f prviding emergency medical services r representing him/herself as an EMS prvider withut a license r certificate, r similar crime directly related t the prfessin f EMS? 12. If yu are r have been certified r licensed as an EMS prvider in this state r anther state, is yur certificate r license currently n prbatinary status r has it been suspended r revked by the bard r the EMS certifying r licensing entity in anther state? The abve infrmatin is true and crrect t the best f my knwledge. I authrize the release f my state examinatin scres t the Ohi Dept. f Public Safety and Cuyahga Cmmunity Cllege. I understand that supplying false infrmatin may mean dismissal frm all EMT classes. Applicant Signature _Date _

10 Emergency Medical Technlgy Self-EvaluatinFrm Self-Evaluatin Frm Name: Student Number: Date: DIRECTIONS Please answer the fllwing questins, chsing the answer that best describes yur current circumstances. Please identify yur current EMT certificatin status. I d nt hld any EMT certificatins. I am a State f Ohi certified First Respnder. I am a State f Ohi certified EMT-Basic. I am a State f Ohi certified EMT-Intermediate. I am a State f Ohi certified EMT-Paramedic. I am EMT certified in a state ther than Ohi. Level f certificatin: Please identify any f the fllwing Healthcare licenses that yu may pssess. I d nt hld any ther healthcare licenses I am a Registered Nurse r Licensed Practical Nurse I am a Respiratry Therapist I hld anther healthcare prfessinal license: Please write a brief self-evaluatin paragraph describing what yu have dne prir t applying t the EMT Prgram, and yur future gals in prviding pre-hspital care. It is acceptable t attach yur wrd prcessed paragraph t this frm. State f Ohi EMS Accreditatin #312 Rev. February 4,