I, ________________________________________________, hereby
Print name here
attest that I can provide proof of my current paramedic certification
(national registry or state certification), and have at least 1 year of active
practice as a paramedic in good standing.
I hereby attest that my response and the information provided on this form
and any related application items for admission into the Community
Paramedic Program at UCCS are true, complete, and accurate and I
understand that this information will be used to verify my official presence
in the program.
Printed Name: _______________________________________________
Signature Name: ____________________________________________
Date: ______________________________________________________