First Name*
Last Name*
Email*
Password*
Address1*
Address2
City*
State*
Zipcode*
Cell Phone*
Alternate Phone
Gender* Select Gender Male Female
Age* -Choose One- 12-17 years old 18-24 years old 25-34 years old 35-44 years old 45-54 years old 55+ Prefer not to state
Date of birth* Please provide your Date of Birth in mm-dd-yy format
I have a current Driver's License which is required to register. Yes, I meet or will meet the above requirement.
I have a high school diploma or a GED. Yes, I meet or will meet the above requirement. The above field is mandatory to enroll in Paramedic Program
I have completed an EMT Basic Course and hold a current EMT Card. Yes, I meet or will meet the above requirement. The above field is mandatory to enroll in Paramedic Program
I hold a current CPR Card from the American Heart Association "Healthcare Provider Level." Yes, I meet or will meet the above requirement. The above field is mandatory to enroll in Paramedic Program
I have completed an Anatomy/Pathophysiology (individual or Combined) or taken a Paramedic Preparation course from an accredited institution that includes it. Yes, I meet or will meet the above requirement. The above field is mandatory to enroll in Paramedic Program
I have a minimum of 1000 hours of part-time or full-time experience as an EMT prior to the application deadline. Yes, I meet or will meet the above requirement. The above field is mandatory to enroll in Paramedic Program
Are you currently employed? Yes No Please select. Are you currently employed?
Business Name or Company Name* Please provide business name or company name.
Address* Please provide address
Contact Name* Please provide contact name.
Contact Phone* Please provide contact phone
Contact Email* Please provide contact email
Have you attended another Paramedic Program? Yes No Please select. Have you attended another Paramedic Program?
I am currently working as an EMT? Yes No I am currently working as an EMT?
Agreement: I hereby certify under penalty of perjury that all information on this application is true and correct to the best of my knowledge and belief, and I understand that any falsification or omission of material facts may cause forfeiture on my part of any rights to a Paramedic. Accreditation in the County of San Diego. I understand all information on this application is subject to verification and audit, and I hereby give my express permission for this certifying entity to contact any person or agency for information related to my role and function as a Paramedic in the State of California. Please accept license agreement.
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.
