EMT Basic Packet check off sheet
All of the following items are prerequisites to enroll for EMT104 at Mesa Community College.
Incomplete packets will not be accepted. Put Copies in order, according to the list below before you
turn packet in. Keep a copy of the packet “for your records”- we do not return paperwork you turn in.
Clinical Option
Option A (Hospital Clinical) ____ Option B (Total Pt. Management) ____ Both A&B ____
____ Have your MCC 8-Digit Student ID#
____ Signed copy of Student Contract (Found inside Packet)
____ Photo copy (200%) of Drivers License verifying age 18 by first class meeting.
____ Photo copy of current Health Care Provider level CPR (front and back)
CPR classes held at MCC recommended by EMT Instructors. You can sign up for
these classes online at www.mesacc.edu or at any MCC Campus. See class schedule for
EMT101 - Healthcare Provider CPR.
____ Photo copy of Reading Assessment test, ASSET, COMPASS, or ACCUPLACER
(See number 4 on Page 3)
____ Photo copy of proof of MMR
(See number 5 on Page 3)
____ Photo copy of current TB skin test (Within 12 months, prior to 1st day of class)
--------------------------------------------------------------------------------------------------------------------Additional Requirements For Selected Options
(Can select both options A & B)
Option A
____ Photocopy of Level 1 Finger
Print Clearance Card from DPS
Or Yellow Copy of Application
Option B
____ Register for Total Pt. Management
Class (EMT104AB)
*This is a .5 credit class (with a $50.00
class fee attached)
____ Signed copy of Acknowledgement of
Criminal Background Check
Requirements (Found inside Packet)
Please deliver completed packets to the EMT/FS office at the Downtown Center at 145 N.
Centennial Way, 4th Floor, Mesa AZ 85201. Students are responsible for photocopying all
documentation. No photocopies will be made at the EMT office.
Dear EMT Student,
Welcome to the Mesa Community College EMT training program. Our goal is to provide you
with the highest level of education in an enjoyable learning atmosphere. In order for you to be
eligible to begin EMT training you must first satisfy the requirements of the Arizona Department
of Health Services. The following requirements are mandatory and require documentation to
ensure compliance. Please read the requirements carefully to ensure compliance. All students
must turn in their completed documentation at the EMT/Fire Science office at the Centennial
Campus at 145 N. Centennial Way. Once we receive your completed documents you will be
given a “permission to enroll” form which will allow you to enroll in any open section of
EMT104 for current semester. You may drop off you documents at any time during the normal
business hours, no appointment is necessary. No copies will be made in our office. It is your
responsibility to bring a completed packet ready to turn in. Call our office at 480-461-6300 or
461-6304 if you have any questions.
The following must be provided at the time of registration for EMT104. If any documentation
is incomplete you will not be given permission for registration.
1. You must have a signed copy of the Student Contract.
2. You must be 18 years of age by to the first class meeting. You must provide us with a
copy of your current Driver’s license or Birth Certificate with picture I.D.
3. You must be CPR certified by one of the following institutions and at the corresponding
level. All training must meet the 2010 guidelines.
American Heart Association……………………..Health Care provider
American Red Cross ………………………………Professional Rescuer
American Safety & Health Institute……………...........CPR Pro
Green Cross or NSC ………………………………Professional Rescuer
Military Training Network………………...“Meets AHA 2010 guidelines
for “Health Care Providers”
You must provide a copy of your current certification card, both front and back sides.
Certification must be maintained throughout the course and during National Registry
testing.
4. Every student, must take the reading assessment test and attain a minimum score of
42 on the ASSET test or 83 on the COMPASS test, or 74 on the ACCUPLACER or
an AIMS score of 720 or higher, Nelson Denny 10th Grade Level, or an associate
degree prior to enrolling.
The tests are given at the MCC main campus at 1833 W. Southern Av., Mesa, Az., 480461-7480. Testing is done Monday through Thursday from 8am to 7pm and Friday from
10am to 4pm. Red Mountain Campus at 7110 E. McKellips Rd, Mesa, AZ, 85207, 480654-7200. You will need to bring a copy of your results to turn in.
5. You must have proof of immunity or immunization to Rubella (German Measles),
Rubeola (Measles), and Mumps. Immunization must be within the last ten years or twice
in lifetime.
6. You must also have a current TB skin test (within the last 12 months prior to start of
class). If you had a positive reaction, you will need to have a chest x-ray with proof of a
negative result.
7. You must provide proof of a current Level One, unrestricted DPS Finger Print Clearance
Card. We will need to view the original card and you will need to provide us with a photo
copy of both the front and back of the card to go with your packet.
(Required for in Hospital Clinical - Option A)
8. You must also have a signed copy of the Acknowledgement of Criminal Background
Check Requirements.
(Required for in Hospital Clinical - Option A)
9. You must register for EMT104AB class at the same time you are registering for the
EMT104 class. Must complete the program as a P/Z (Pass/Fail), attend the complete
class, and meet all competencies.
(Required for – Total Pt. Management Clinical - Option B)
10. You must submit to a “Standard Plus II” urine drug screen at Sonora Labs.
Results will be sent directly to MCC. Testing will be done the first week of class and
the student must pay the testing fee at the testing site.
(Required for in Hospital Clinical Option A)
The above requirements are for your safety and wellbeing. Compliance will involve some effort
on your part. Please remember to include copies of all your required documentation to the
EMT/Fire Science office. No partial packets will be accepted. Please call (480) 461-6300 or
(480) 461-6304 at the EMT/ Fire Science office if you have any questions. Thank you for your
cooperation and we look forward to seeing you.
Sincerely,
Christopher M. Burrows
Occupational Program Director
Mesa Community College
Mesa Community College
EMT PROGRAM
POLICIES AND PROCEDURES FOR EMT BASIC
Attendance
All registered students must attend the first class meeting to assure their seat in the class.
Any student that does not attend the first class will be dropped from the course and will
lose their spot. Absences and tardiness shall not exceed 16 hours.
The course instructor may have more stringent attendance requirements that will be stated
in the course syllabus. Any student who has in excess of 16 hours for any reason or 3
consecutive classes will be unable to continue in the course. Any student wishing to drop
the course must do so on his or her own by calling the phone registration office at 480461-7700 or by going to the Southern & Dobson campus or at the Downtown Center.
Students wishing to drop the course must do so during the first week of class in order to
receive a 100% refund. After the second week of the course, there may be no refunds of
tuition or course fees. If you have an emergency and will not be in class on the first day,
please contact the EMT/Fire Science office ASAP at 480-461-6300 or contact your
instructor.
OPTION A: Clinical Rotation (Required for in Hospital Clinical - Option A)
You are required to attend and participate in (1) ten-hour clinical rotation at a local
hospital emergency room. You must have a DPS Level 1, unrestricted Finger Print
Clearance card, the results of a “NEGATIVE” drug screen and the Banner Health
Systems background check and educational modules completed before signing up for
your clinical rotation. You are responsible for meeting all of the preclinical requirements.
Any issues that arise obtaining clearance are between the student and agency, not
MCCCD. If you are too ill to attend your scheduled rotation, it is your responsibility to
contact the E.R. before your scheduled time and advise them that you won’t be
attending. The student must also notify their instructor immediately. The student must
put their name on the clinical makeup list in the EMT office and it is that student’s
responsibility to check at the EMT office for their makeup date and time. Any student
that has not completed the clinical experience by the end of the current semester will be
required to re-enroll in the EMT104 course, pay full tuition, and repeat the missed
clinical. This is required because of insurance reasons.
Clinical rotations are evaluations of your behavior and knowledge. Evaluations must be
favorable for your hours to apply. Clinical experience is a privilege allowed you by the
hospital. Dress code will be your grey EMT program shirt, Dark blue long pants (Dockers
type) and black shoes. You are expected to behave in a courteous and respectful manner
and represent the MCC program in a positive way. Tobacco use is prohibited while
attending the clinical.
Drug testing
(Required for in Hospital Clinical - Option A)
You must submit to a urine drug test during the first week of class. You will be given a
permission form to go to any Sonora Quest Labs Drug testing site and provide a sample.
You will be responsible for the test fee. Results will be sent directly to the EMT
Program Director. You must provide a “NEGATIVE” drug screen to be eligible to
complete your clinical rotation. You will be contacted by a physician from Total
Compliance Network if there are questions concerning your results. Only the TCN
physician can change a “POSITIVE” result to a “NEGATIVE”. The final determination
of the TCN physician will be upheld by MCC EMS Medical Director and Program
Director.
Grading
To be eligible to take the National Registry “Computer Adaptive Test” exam for
certification you must complete the course with an “A” or “B” (84% or better). You
must also pass the class written final for the course with a minimum grade of 75%. You
must pass the practical skills examination with a minimum of 80% of the possible points
in each skill. You will be allowed a maximum of 3 attempts to pass the written and
practical skills tests. If a student does not attain a minimum passing grade on the 3rd
attempt, the student is not eligible to pass the course.
Supplies
Students are responsible for any and all writing and note-taking supplies.
Students are required to provide their own textbooks required for the course:
 Text book information will be provided at registration in the EMT/FSC office.
 Clinical uniform (required). You will be given your shirt in class before clinicals
start.
 Stethoscope and B/P Cuff (Can be purchased through EMT/FSC Office)
Course Completion Requirements
The MCC Training Program will allow students who have failed to complete any portion
of the course requirements no more than 6 months from the official completion date of
the course to complete all requirements. A final grade of 84% or higher in the class,
completion of the clinical rotation, successful completion of the practical skills and
written final are required to be eligible to take the National Registry “Computer Adaptive
Test” exam for certification
National Registry Computer Adaptive Test Testing
Students who successfully complete all portions of the course will be notified by an
“ATT” authorization to test letter, in their National Registry account when they are
eligible to schedule their exam. The “ATT” will show in the account within two to three
weeks after the course is completed.
Option B: Total Pt. Management Clinical
Must Register for and complete the program as a P/Z (Pass/Fail). Attend all of class and meet all
competencies.
Applied Practical Studies For Emergency Medical Technology (EMT104AB) 0.5
Credits
Simulation of actual emergency responses, with practical application of techniques and skills covered
in EMT curricula. Scenario based learning applied to the techniques of emergency medical care in
accordance with national and state curriculum. Practical application of anatomy, physiology, patient
assessment, and treatment of medically or traumatically compromised patients, special hazards and
medical operations. Also includes patient-assisted medication administration, semi-automatic external
defibrillator and blood glucose monitoring. Students function in outside, scenario based environment.
Prerequisites: None. Co-requisites: EMT104, or permission of Instructor.
EMT Student Contract
I_________________________________________ by signing this contract agree with the following:
My MCC 8-Digit Student ID # is _____________________
1)
I am or will be 18 years of age by the first meeting of class.
2)
I am currently certified in CPR at the “Health Care Provider” level by the American Heart Association or
“Professional Rescuer” level by the American Red Cross or “CPR Pro” by the American Safety and Health
Institute (ASHI).
3)
I have completed the reading ASSET test with a minimum score of 42 or the COMPASS test with a
minimum score of 83 or ACCUPLACER test with a minimum score of 74 or other based on packet page 3
Number 4.
4)
I have documented proof of immunity or immunization of MMR.
5)
I have documented proof of a TB skin test with a negative result or chest X-ray with a negative diagnosis if
skin test is positive within the last 12 months.
6)
I have a current Level 1 Finger Print Clearance Card from Department of Public Safety or a copy of the
pending application. (Required for in Hospital Clinical - Option A)
7)
I have signed the Acknowledgement of Criminal Background Check Requirements. (Required for in
Hospital Clinical - Option A)
8)
If I am not Utilizing Option A Hospital Clinical, I will fulfill the requirements of Clinical Option
B Total Pt. Management. I will register for this option (EMT104AB) when I register for the
EMT104 class. (Required for Total Pt. Management – Option B)
9)
I have received a copy of the policies and procedures of the MCC EMT-basic Training Program and I
understand them fully.
10)
I understand that I may not miss any more than a cumulative of 16 hours or 3 consecutive classes of the
entire MCC EMT-basic Training Program. If for any reason and that I may be dropped from the course and
forfeit any tuition or fees paid if I violate this rule. No exceptions.
11)
I understand that I must receive a minimum 84% overall grade in the class and complete 10 hours of
hospital clinical rotations to be eligible to take the National Registry exam for certification.
12)
I understand that I must submit to a urine drug screen at Sonora Quest Labs (Standard Plus II # 102421)
during the first week of class. The charge for the test must be paid by the student at the time of the
test.
(Required for in Hospital Clinical - Option A)
**I also understand that if I miss the drug screening during the allotted time period I will be
ineligible for participation in the hospital. Drug screen results must be determined to be
“NEGATIVE” to be cleared for clinical rotations.
Signature____________________________________________ Date______________
Rev. 04/13