Hybrid Paramedic Program Application (Cohort 25-2)

After submitting your application you will be emailed instructions on how to upload and send the below required documents. Please make sure to only upload documents in a PDF format. For each PDF that is uploaded, please name each PDF with your last name and first name and what the document is. For example, Smith_John_Resume.

Please note: * (asterisk) Indicates a required field.

Personal Information

Name:
Address:
Phone:

Demographics

Gender:

Which best describes your gender? Choose all that apply.

Ethnicity origin and or Race:

Which of the following best represents your racial/ethnic heritage? Choose all that apply.

General Information

VA Benefits:

Will you be using VA benefits to pay for tuition?

Drivers License:

Do you have a current drivers license?

Education History

High School:
Do you hold a GED:
EMT Basic Course Completed:

Have you completed an EMT Basic Course?

EMT Basic:
Prior Paramedic Education:

Have you previously attended another Paramedic Program?

Paramedic Education:
Paramedic Program Dismissal:

Have you ever been dismissed from a Paramedic Program for academic or behavior issues?

If yes, please provide a brief description of the circumstances surrounding the dismissal and what changes you have made in order to be successful in the future.

(100 characters left)

College Degree:
Anatomy & Physiology:

Have you taken a college level Anatomy and Physiology course?

Pre-Paramedic course:

Have you taken a Pre-Paramedic course?

EMT License Information

State/NREMT EMT Certification :

Employment History

Do you currently have a job:
Are you currently working as an EMT?:

Employer: EMT Experience Add More

Please add employers where you gained your EMT experience, if applicable.

(150 characters left)

Add More

How Did You Hear About Us?

How did you hear about the Sacramento State Paramedic Program:

(Check all that apply)

Uniform and Interview Selection

Interview Time:

Interviews are required for those that apply and meet the minimum qualifications for the Hybrid Paramedic Program.

What size polo shirt will you need?

What size sweatshirt will you need?

What size scrub top will you need?

What size scrubs pant will you need?

Agreements

Application Fee:

The $30 application fee is non-refundable and must be paid via a separate online form. Once you click submit, the next page will display the link to the application fee. The link to the application fee will also be included in your confirmation email. Your application will NOT be considered if the application fee is not paid.

I understand that in order to participate in this program, I will be required to do a 10-panel drug screening, and agree to a background check. Drug screening and background checks will be completed upon acceptance to the program.

I certify under penalty of perjury that I have provided complete and accurate responses to the items listed on this application.

Privacy Policy:

The College of Continuing Education respects your right to privacy. Any information given to us when requesting course or program material will be used solely for the purpose of answering or responding to your request. We do not sell or otherwise distribute your personal information. We may, however, use it to provide you with advanced notices of our course offerings. If at any time you wish to be removed from our mailing lists, you may contact us and your request will be processed immediately.

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