Paramedic Academy Application 2019-2020 Paramedic Academy Application First Name* Last Name* Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Email*The program will communicate through email - make sure this is an account you check frequently! UA ID*University of Alaska Student ID Number (if none state why) Phone*Emergency Contact*Include Name and Phone NumberUS Citizen*Are you a US Citizen? No Yes Anatomy/Physiology Course*Have you "completed" an Anatomy and Physiology Course? No Yes EMT certificate*Please upload your EMT certificateMax. file size: 200 MB.CPR Credential*Please upload a current copy of your CPR Credential (Must be BLS provider card)Max. file size: 200 MB.Health Insurance*Please upload proof of current health insurance, health insurance must be maintained throughout the courseMax. file size: 200 MB.Admission Essay*Please upload a one page paper on why you wish to attend the academy, in one of the following formats, PDF, RTF, or DOCXAccepted file types: pdf, rtf, doc, docx, Max. file size: 200 MB.Resume*Please upload a current resume in one of the following formats, PDF, RTF, or DOCXAccepted file types: pdf, rtf, doc, docx, Max. file size: 200 MB.Pre-Paramedicine core courses*Have you completed the Pre-Paramedicine core courses for the AAS Paramedicine? No Yes Photo*Please upload a current passport style photo (face shot)Max. file size: 200 MB.Background Check*Please upload a current copy of your background check (obtained from AK State Troopers or your home state)Max. file size: 200 MB.VaccinationsPlease provide documentation of the following vaccinations or titer. Measles, mumps, and rubella (MMR) (2 shot series). Varicella (2 shot series or blood test) Drop files here or Select files Max. file size: 200 MB. Reference LettersPlease Upload Three Letters of Recommendation Drop files here or Select files Max. file size: 200 MB, Max. files: 3. Δ
