Dear Prspective Emergency Medical Technlgy Student, Thank yu fr yur interest in the Emergency Medical Technlgy (EMT) prgram at Cuyahga Cmmunity Cllege (Tri C ) where futures begin. Our prgram is accredited by the State f Ohi Divisin f EMS t ffer Emergency Medical Respnder, EMT, Advanced EMT and Paramedic Certificatin curses. We als prvide cntinuing educatin fr all levels f EMT. The EMT prgram is fcused n student success. We are pleased t help yu design a plan fr yur success here at Tri C, as well as in yur EMS career. We wrk clsely with Fire Academy staff t help thse seeking a career in firefighting t attain their gals. The Cllege accepts applicatins fr the EMT prgram n a cntinual basis. 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. EMT certificatin classes are ffered every semester. The Paramedic certificate prgram begins each fall and spring semester. Questins pertaining t Tri C s EMT prgram may be directed t the EMT ffice at 216 987 4449. We wish yu success in reaching yur educatinal gals. Sincerely, Ed Bak Prgram Directr Emergency Medical Technlgy Phne: 216 987 4449 Fax: 216-987-4386 edward.bak@tri c.edu 2900 Cmmunity Cllege Ave. MHCS 126 H Cleveland, Ohi 44115 Encl: Health Careers Applicatin; EMT Prgram Applicatin
Cuyahga Cmmunity Cllege (Tri-C ) Emergency Medical Technlgy Emergency Medical Technlgy Prgram Emergency Medical Technlgy Prgram The Emergency Medical Technlgy department at Tri C rutinely ffers: Shrt Term Certificate fr EMT Basic Certificate f Prficiency 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 certificate prgrams are applied tward the AAS in EMT r Fire EMS. The prgram can be accmplished in a traditinal cllege degree sequence, r students may take the EMT and Paramedic certificate curses first and then cmplete the assciate degree requirements after achieving state certificatin and pursuing emplyment. Prgram Admissin 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 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 pre review 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. 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. An nline applicatin is available at http://www.tri c.edu/apply. Cmplete Tri C English and math assessment tests. Sample tests and infrmatin abut the assessment centers are available at http://www.tri c.edu/placement testing/index.html. Cmplete the Health Careers Prgram Applicatin as well as the EMT prgram applicatin s Student Infrmatin and Self Evaluatin frms. The Health Infrmatin frm can be frwarded later. Additinal EMT infrmatin is available at http://www.tri c.edu/emt. Health Careers Enrllment Center Cuyahga Cmmunity Cllege 2900 Cmmunity Cllege Ave. MHCS 126 Cleveland, Ohi 44115 3196 State f Ohi EMS Accreditatin #312 Rev. June 1, 2016 2
Cuyahga Cmmunity Cllege (Tri-C ) Emergency Medical Technlgy EMT Certificatin and Shrt Term 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 entry level training fr the prfessinal pre hspital care prvider. Students wh successfully cmplete the prgram are eligible t take the Natinal Registry f EMTs cgnitive exam, 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 is an academic credential awarded by Tri C that includes Anatmy and Physilgy fr Paramedics (EMT 1401). This curse is required 1 t advance t the Paramedic prgram. Admissin Requirements Minimum Age General Admissin t Tri C English and Math Backgrund Check 18 years f age r 17 years f age and a high schl senir. Cmplete general requirements fr admissin (described n 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 http://www.tri c.edu/prgrams/health careers/backgrund checkinfrmatin bci.html. Directins fr the backgrund check are available at the link at the bttm f the page. Once these requirements are met, cntact EMT prgram manager t secure departmental apprval t register. Field Experience Requirements 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 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 130L. Prvide prf f persnal health care insurance. CPR Successful cmpletin f the Basic Life Supprt fr the Health Care Prvider cmpnent f the curse. 1 BIO 2331 and BIO 2341, Anatmy and Physilgy I and II may be substituted fr this curse. State f Ohi EMS Accreditatin #312 Rev. June 1, 2016 3
Cuyahga Cmmunity Cllege (Tri-C ) Emergency Medical Technlgy Paramedic Certificatin and Shrt Term Certificate Anticipated Curse Expenses (2018 2019) Estimated Csts fr EMT Basic Certificatin (EMT 1302 and EMT 130L) In Cunty In State Out f State Tuitin 801.78 1008.56 1898.33 Backgrund check, estimate, additinal cst fr ut f state residency 99.80 99.80 121.00 Textbks, unifrm, medical equipment 385.00 385.00 385.00 Clinical unifrm shirt 35.00 35.00 35.00 Medical liability insurance 12.50 12.50 12.50 Subttal fr EMT Basic Certificatin 1,334.08 1,540.86 2,451.83 Estimated Cst fr Anatmy and Physilgy fr Paramedics (EMT 1401) Tuitin 458.16 576.32 1084.76 Texts and instructinal materials 98.75 98.75 98.75 Subttal fr Anatmy and Physilgy fr Paramedics 556.91 675.07 1,183.51 Ttal EMT Shrt Term Certificate (includes Paramedic prerequisites) 1,890.99 2,215.93 3,635.34 Paramedic Certificatin Prgram and Shrt Term Academic Certificate Prgram Descriptin This prgram is significantly revised, effective fall 2012. The Paramedic certificate prgram requires successful cmpletin f the EMT Basic certificatin prgram, including Anatmy and Physilgy fr Paramedics (EMT 1401). This serves as the state required anatmy and physilgy prerequisite fr Paramedic certificatin. Students wh have cmpleted BIO 2331 and BIO 2341 (Anatmy and Physilgy I and II) may substitute these fr EMT 1401. Students wh cmpleted EMT training thrugh anther institutin will need t take either 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 2370 (Paramedic Thery I V) 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 EMTs Paramedic test, the state f Ohi s certificatin examinatin. Admissin and Retentin Requirements Minimum requirements fr admissin int the Paramedic Certificatin prgram are listed belw. General Admissin 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 Paramedic Thery I (EMT 2330). Eligibility fr ENG 1010 and MATH 0955 n placement exams t cntinue int EMT 2330. Maintain a C r higher in EMT 1401 and EMT 2330 thrugh 2360. If new t the prgram, r returning mre than tw years after beginning EMT, cmplete required Health Careers apprved backgrund check. Additinal infrmatin abut backgrund check available at http://www.tri c.edu/prgrams/health careers/backgrund checkinfrmatin bci.html. Once these requirements are met, cntact EMT prgram manager t secure departmental apprval t register. State f Ohi EMS Accreditatin #312 Rev. June 1, 2016 4
Cuyahga Cmmunity Cllege (Tri-C ) Emergency Medical Technlgy Assciate f Applied Science in EMT Clinical/Field Experience Requirements TB testing and vaccinatins Physical Exam Liability Insurance Health Insurance CPR EMT Certificatin 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 2340. Prvide prf f persnal healthcare insurance. Prvide evidence f current CPR credentials fr the Health Care Prvider. Prvide evidence f State f Ohi EMT certificatin. Anticipated Curse Expenses (2018 2019)* Estimated Csts fr Paramedic Certificatin Prgram In Cunty In State Out f State Tuitin 3321.66 4178.32 7864.51 Backgrund check, estimate, additinal cst fr ut f state residency 99.80 99.80 121.00 Textbks, unifrm, medical equipment 450.00 450.00 450.00 Clinical unifrm shirt 35.00 35.00 35.00 Medical liability insurance 12.50 12.50 12.50 Ttal fr Paramedic Certificatin 3,918.96 4,775.62 8,483.01 *Textbk cst estimates are preliminary, due t changes in curriculum and ptential adptin f new learning materials. Assciate f Applied Science in EMT Prgram Descriptin The Assciate f Applied Science degree prgram in Emergency Medical Technlgy: Includes EMT Basic and Paramedic certificate curses. Transfers t fur year clleges t cmplete a bachelr s degree. Maybe cmpleted in a traditinal manner r after cmpleting the certificate curses. Is designed t build the academic skills and backgrund knwledge needed fr success in the field and t prvide cmmn grund with ther health prfessinals. Tri C Fire Academy credits include an AAS in EMT elective. Mre infrmatin available at http://www.tric.edu/wrkfrce/public safety/fire ems training/firetraining academy/index.html. Cnfers additinal academic credential, imprtant fr thse seeking cmpetitive psitins. Details n the AAS in EMT are available at www.tri c.edu/emt. State f Ohi EMS Accreditatin #312 Rev. June 1, 2016 5
Cuyahga Cmmunity Cllege (Tri C ) Received: HEALTH CAREERS PROGRAM APPLICATION Please Print r Type All Infrmatin Full Legal Name: Prgram f Applicatin Last First Middle Frmer, if applicable Address: Apt#: Telephne: ( ) City: State: Zip Cde: Cunty: Student Number: (This can als be yur scial security number) Email 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 may be submitted t the Admissins Office alng with applicatin t the Cllege by the applicant. If yu are transferring credits frm anther cllege r university, yu must btain an unfficial cpy f yur transcript t be included in the EMT 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) Are yu a military service veteran? Yes N Have yu ever been cnvicted f a felny? Yes N Misdemeanr? Yes N 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 and disabled veterans in all levels f the Cllege. It is als the intent f the Cllege t ensure that its envirnment i s free frm harass mentr 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): Date: Revised 6/2011
Cuyahga Cmmunity Cllege (Tri C ) 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 Basic Certificate EMT Paramedic Certificate f Prficiency Day Evening Fall Spring Summer EMT Assciate Degree Fire EMS Assciate Degree Health Infrmatin Management Metr Day Evening Sprt and Exercise Studies East Metr West Medical Assisting Certificate(One Year) East Metr West Westshre Medical Assisting Assciate Degree East Metr West Westshre _ Eastern Campus Based Prgrams Pharmacy Technlgy Day Evening Certificate (One Year) AAS Degree (Tw Years) _ Metrplitan Campus Based Prgrams Cancer Registrar Pst Degree Health Unit Crdinatr Occupatinal Therapy Assistant Certificate (One Year) Human Services Optical Technlgy Year) 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 (One Medical Billing Specialist Certificate (One Year) Medical Labratry Technlgy (Tw Years) Sterile Prcessing and Distributin (One Year) Surgical Technlgy _ Western Campus Based Prgrams Diagnstic Medical Sngraphy (Select Optin Belw) Abdminal/Ob/Gyn 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
Cuyahga Cmmunity Cllege Nursing and Allied Healthcare Career Prgrams Backgrund Check and 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 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 (1 888 823 4263). 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 prgram 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 11.15.12/Rev 11.2.16 Healthcare Educatin Initiatives Frm N. HEI 1 K:\Academic & Student Affairs (ASA)\Medical Educatin Prgrams\Standardized Student Dcuments
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 OAC4765 8 01 A: 1. Are yu at least 18 years ld r a17 year ld high schl senir r graduate? Yes N 2. 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 4765 8 01 (a)(6) f the Ohi Administrative Cde? Yes N 3. Have yu ever been adjudicated mentally incmpetent by a curt f law? Yes N 4. 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? Yes N 5. Have yu ever cmmitted fraud r material deceptin in applying fr r btaining a certificate t practice under Chapter 4765 f the Revised Cde? Yes N 6. Have yu been cnvicted, in this state r anther state, f prviding emergency medical services r representing yurself as an EMS prvider withut a license r certificate, r a similar crime directly related t the prfessin f EMS? Yes N 7. 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? Yes N 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 _
Cuyahga Cmmunity Cllege (Tri-C ) Emergency Medical Technlgy Self Evaluatin Frm 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 health care licenses yu may pssess: I d nt hld any ther health care licenses. I am a registered nurse r licensed practical nurse. I am a respiratry therapist. I hld anther health care 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 a wrd prcessed paragraph t this frm. State f Ohi EMS Accreditatin #312 Rev. 02/2015 2