Application to Attend EMT Basic Course

Missoula Emergency Services Inc.

1200 Burlington Ave

Missoula, MT  59802

(406) 549-2325

Name:

Address:

Phone:

Social Security Number

(As you would want it to appear on your license)

Mailing Address:

(This number is used for License Purposes)

Brief history of EMS Experience and EMS education

• No application is considered complete unless accompanied by payment of class fees in full.  Missoula Emergency Services accepts Visa, Mastercard, check, or cash.

• Completed Applications must be returned by Feb. 16th to be considered.

Please keep this portion with you

 

• Class will be held Mondays and Tuesdays from 1700-2200.

 

• Please have available a copy of your MMR vaccinations and TB test.  This is a requirement for your clinical rotations.  TB testing and MMR vaccinations are available through the University Health Care System (Curry Health Center) or at the Missoula County Health Department (301 W. Alder St.).

 

• Completed applications must be returned by February 16th to be considered.

 

• Cost of the BLS course is $800.00.  Students are responsible for their book costs.  Students will be able to pick up their text at the University of Montana Bookstore prior to the first day of class (near or before February 2nd).  Students are strongly encouraged to purchase the workbook that accompanies the text.  The textbook is called Emergency Medical Technician making the Difference and is published by Mosby Jems (Elsevier Publishing).

 

 

 

 

 

Thank your for your interest in Missoula Emergency Services, Inc. EMT-Basic course.  We look forward to having you as a student.