Emergency Medical
Services
Intermediate
1-year Generic Program
EMS Intermediate Career Studies Certificate
Information and Application Forms
For further information and questions, please contact the Nursing & Allied
Health Office:
Mrs. Carol Griffin, Administrative Assistant
Phone: 757-569-6731
E-mail: cgriffin@pdc.edu
Nursing & Allied Health Office, Room 136H
Paul D. Camp Community College
Box 737
Franklin, Virginia 23851
Official transcripts are REQUIRED for admission. Prospective students should request that
official transcripts from high school, GED scores, as well as all colleges and adult education
centers attended be sent to the above address.
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The EMS Intermediate Program
Degree: EMS Intermediate Career Studies Certificate
Length of Program: One year involving 2 Continuous Semesters with a Virginia EMT
Certification and 3 without the EMT Certification.
The concept of our program is to provide an opportunity for those interested in an EMS career to
acquire the knowledge, skills and experience of the scope of practice of the EMS Virginia
Intermediate technician. Upon completion of the program, graduates have met the educational
requirements necessary to be eligible to take the Virginia Intermediate exam and obtain Virginia
Certification as an Intermediate technician.
Steps for Applying to the EMS Intermediate Program
Note: Application to the EMS Intermediate Program requires a separate and additional process
beyond being admitted to the College. The necessary EMS Intermediate program application
forms are included at the end of this packet.
1. Submit an application to Paul D. Camp Community College [PDCCC] (complete
a new one if you have attended previously but have a different phone number,
address, last name, etc.).
2. Submit an application to the PDCCC EMS Intermediate Program. The form is
included at the end of this packet. Submit the EMS Intermediate Program
application to:
The Nursing & Allied Health Office, Room 136H
Paul D. Camp Community College
Box 737, 100 North College Drive
Franklin, Virginia 23851
3. Arrange for ONE OFFICIAL COPIES OF EACH of the following to be sent to
the Nursing & Allied Health Office. Use the address above.
i. High school transcript or GED certification scores
ii. Any Health Care Program/School transcript and license/Certification
iii. Transcripts from all colleges (other than PDCCC) or adult education
centers attended
4. College Placement Assessment Tests if you have not done so already. If it has
been several years, repeat the tests to update your profile. If you have already
taken through Math 05 (algebra), you do not have to take the math placement test.
If you have already taken English 111 (English Composition) at PDCCC or
another college, you do not need to take the Writing Test. All students must take
the reading placement test regardless of documented college courses.
To schedule an appointment to take the placement tests, call the admissions
office in Franklin (569-6707 or 6722), Suffolk (925-6312 or 6313), or Smithfield
(925-6340) or go to any of the admissions offices. Take your copy of the
placement test results to the nursing office to be placed in your files and for
advising as necessary.
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5. Consult one of the financial aid offices if you intend to apply for financial aid or
scholarships. Call 569-5615 in Franklin. Call 925-6346 in Suffolk.
6. Arrange to meet with the EMS Education Coordinator or an Allied Health advisor
(569-6731) to make a plan for the courses you will take each semester. YOU
MUST FIRST TAKE THE DEVELOPMENTAL COURSES
RECOMMENDED BY PLACEMENT TEST SCORES. You need to take
math courses through Math 05, but not beyond.
7. Take pre-requisites courses that are not already on your high school or college
transcript. You must have:
a. Virginia Office of EMS Approved Cardio Pulmonary Resuscitation
Course (CPR)
b. Math 05 or math placement test scores that does not recommend taking
through Math 05.
c. Any other developmental courses recommended by the placement tests
(writing and reading test results).
8. Maintain a cumulative and curricular GPA of 2.5 or better in the general
education courses in the EMS curriculum (See page 5). If you have not taken
courses in the EMS curriculum, the GPA from your most recent education
experience will be used. The grades on EMS Intermediate program required
general education courses taken at other institutions will be used in the calculation
of your curricular GPA.
9. Arrange to have three letters of recommendation sent to the Nursing & Allied
Health Office by people who have interacted with you in the past two years. At
least one must be an academic teacher or guidance counselor or work supervisor.
The letters are to be sent to the Nursing & Allied Health Office by June 19st.
Letters of recommendation forms are attached to this packet.
10. Submit all transcripts, recommendations, and application materials no later than
June 19st prior to the August in which you hope to attend the program. Check by
email (cgriffin@pdc.edu) or phone (757-569-6731) to be sure all paperwork has
arrived.
11. Evidence of U.S. citizenship or authorization to reside in the United States
If you have all of these prerequisites and have taken all developmental courses
recommended by placement testing, you have met the MINIMUM QUALIFICATIONS for
the EMS Intermediate Program and your application will be included in the next round of
applications reviewed IF all paperwork for the application process (including all placement
testing, transcripts, recommendations, etc.) is received in the Nursing & Allied Health
Office by June 19st prior to the August in which you hope to begin the program.
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Admission Criteria
Once all required paperwork is submitted to the Nursing & Allied Health Office and you have
completed all pre-requisite classes, each student will be considered for admission based on the
following criteria:
a. Academic achievement as shown by cumulative and curricular GPA* or most recent GPA
if no current curricular GPA has been established. Candidates, who have taken any general
education courses required for the degree and receive a grade of “D” or less, must repeat
the course and successfully pass with a C or better before being granted final admission to
the program.
b. Grades of “C-” and below are not transferable into the nursing and allied health programs.
c. Evaluation of recommendations required by the application process.
d. Number of courses taken at PDCCC
Priority will be given to qualified students who attend PDCCC and reside in its service area.
Applicants from other parts of Virginia and applicants from other states will be considered only
after service region students are considered.
Enrollment Details
Qualified applicants will be advised by letter from the Nursing & Allied Health Office of
additional preadmission procedures inclusive of but not limited to:
a. Completion of the preadmission physical examination inclusive of laboratory testing and
required immunizations.
b. Preadmission mandatory orientation session.
c. Ordering uniforms and picture id badge.
d. Proof of CPR certification as “Health Care Professional” through an approved Office of EMS
CPR Program
e. Official State Police Criminal Records (Criminal History Request and Sex Offender Crimes
against Minors) Background checks and drug testing are required by clinical facilities. An
independent agency will conduct these checks and they must be completed prior to the start
of nursing and allied health classes.
Once enrolled in EMS courses, students must comply with the rules and regulations as outlined
in the College Catalog and EMS Student Handbook. Students must minimally maintain:
a. Current CPR certification in “Health Care Professional” status through an approved Office of
EMS CPR Program.
b. At least 2.5 curricular GPA
c. Satisfactory clinical performance
d. Satisfactory physical and mental health
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e. Documentation of certain immunizations to include yearly Tb test or chest x-ray.
f. Professional demeanor and attendance (as measured by tests and instructors’ observations).
Attendance standards for both class and clinical experience must be met. Students must pass
each curricular EMS course to proceed to the next. Students must pass tests on dosage
calculations and clinical skills, and must demonstrate clinical competence in EMS courses with
clinical components.
Any student who receives a final grade lower than “C” in any of the courses required for the
EMS Intermediate Certificate Program will not be permitted to continue in the EMS Intermediate
Certificate Program until the grade is a “C” or better. In order to resume, students must write a
letter to the EMS Program Coordinator to request re-admission.
Students are responsible for additional fees charged for:
Official State Police Criminal Records background checks (Criminal History Request and Sex
Offender Crimes against Minors) and urine drug testing are student expenses (~$110.00 payable
through Certified Backgrounds).
*Curricular GPA is calculated by only using the information from courses in the EMS
curriculum. Add up the number of hours of the classes you have taken. The number of hours of
the class is the number stated in registration information (for example ENG 111 has 3 hours and
BIO 141 has 4 hours). Add up the number of credits you have obtained from each of the
curricular classes. Credits are determined by the grades you get on each course. For A - 4 credits
per hour; for B - 3 credits per hour; for C –2 credits per hour; for D - 1 credit per hour; for F - 0
credits per hour). For example, BIO 141 has 4 hours. If you get a B on BIO 141, you multiply the
number of hours (4) by the credits per hour (3): 4 hours multiplied by 3 credits per hour equals
12 credits. Divide the total credits from all curricular classes by the total number of hours for all
curricular classes.
Ex. ENG 111 with a C is 3 hours and 6 credits (3 x 2 for a C)
BIO 141 with a B is 4 hours and 12 credits (4 x 3 for a B)
PSY 201 with an A is 3 hours and 12 credits (3 x 4 for an A)
The curricular GPA with these classes would be 30 credits divided by 10 hours = 3.000
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EMS INTERMEDIATE CURRICULUM
Program Requirements: To complete the Career Studies Certificate for the EMS
Intermediate Program the student must complete the courses listed below. Note: This
curriculum is subject to minor changes. Please consult the Nursing & Allied Health Office
from time to time for updates.
PROGRAM REQUIREMENTS (27 CREDITS) – TAKEN ONLY AFTER ENTRY INTO
THE EMS INTERMEDIATE PROGRAM.
EMS 111
EMT-Emergency Medical Technician
(7)
EMS 120
EMT Clinical
(1)
EMS 151
Introduction to Advance Life Support
(4)
EMS 153
Basic ECG Recognition
(2)
EMS 155
ALS-Medical Care
(4)
EMS 170
ALS Clinical Internship I
(1)
EMS 157
ALS-Trauma Care
(3)
EMS 159
EMS Special Populations
(3)
EMS 172
ALS Clinical Internship II
(1)
EMS 173
ALS Field Internship
(1)
Minimum Credits Required:
27
SEQUENCE OF CLASSES
EMS 111
EMS 120
Semester 1
Emergency Medical Technician - Basic
EMT-Basic Clinical
EMS 151
EMS 153
EMS 157
EMS 170
Semester 2
Introduction to Advance Life Support
Basic ECG Recognition
ALS Medical Care
ALS Clinical Internship
EMS 155
EMS 159
EMS 172
EMS 173
Semester Total
Semester 3
ALS-Trauma Care
EMS Special Populations
ALS Clinical Internship
ALS Field Internship
Semester Total
Minimum Credits Required: 27
7
1
_
8
4
2
4
1
_
11
3
3
1
1
_
8
27
.
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Course Cost (Approximation)
APPROXIMATE COSTS FOR STUDENTS IN THE EMS INTERMEDIATE PROGRAM
Tuition & Fees
In State
Out-Of-State
Medical Examination (varies with practitioner)
Books (approximate)
Uniforms (EMS Pants, Black shoes, photo ID Badge, polo, etc.)
Virginia Intermediate Exam
FISDAP Clinical and Testing
CPR Certification
Criminal History & Sex Offender Background & Drug Screening Checks
Approximate Totals
EMS program
In-State residents
out-of-state
$3568.05
$6208.25
~$600.00
~$250.00
~$150.00
$100.00
$185.00
$100.00
$110.00
$5063.05
$7743.25
FINANCIAL AID and SCHOLARSHIPS: If you wish to apply for financial aid or
scholarships, you should contact Mrs. Theresa Harrison, (569-6715; tharrison@pdc.edu)
early in the semester BEFORE you plan to enroll. The Suffolk Campus contact Marie
Linton (925-6307; mlinton@pdc.edu).
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PDCCC’s EMS Programs Clinical Requirements
Areas
EMT
To
AEMT
AEMT To
Intermediate
Bridge
EMT
To
Intermediate
Intermediate
to Paramedic
Bridge
EMT
To
Paramedic
Clinical Requirements:
Emergency Department1
Critical Care Area2
Pediatrics3
Labor & Delivery4
OR/ Recovery
Other Clinical Settings5
24 hrs.
PRN
16 hrs.
8 hrs.
8 hrs.
8 hrs.
8 hrs.
PRN
40 hrs.
8 hrs.
8 hrs.
8 hrs.
8 hrs.
PRN
40 hrs.
8 hrs.
8 hrs.
8 hrs.
8 hrs.
PRN
40 hrs.
16 hrs.
16 hrs.
16 hrs.
16 hrs.
PRN
Total Minimum Clinical Hours
36 hrs.
48 hrs.
72 hrs.
72 hrs.
104 hrs.
ALS Medic Unit (Field Internship)
24 hrs.
36 hrs.
60 hrs.
60 hrs.
120 hrs.
Total Minimum Field/Clinical Hrs.
60 hrs.
84 hrs.
132 hrs.
132 hrs.
224 hrs.
30
30
60
60
120
2
2
-
3
3
-
5
5
-
5
5
2
10
10
2
2
2
3
3
5
5
5
5
10
10
2
2
3
3
5
5
5
5
10
10
5
5
5
-
5
5
5
5
-
10
10
10
5
-
10
10
10
5
2
20
20
20
10
2
15
25
20
20
-
15
15
15
10
1 Real Patient
30
25
25
20
1 Real Patient
30
15
25
10
1 Real Patient
10 (6)
15 (8)
25 (15)
25 (15)
60
25
50
20
5 Real
Patients
50 (30)
Total Patient Contacts
Competencies:
Pediatric Assessments:
Trauma7
Medical7
Neonatal Care
Adult Assessments:
Trauma
Medical
Geriatric Assessments:
Trauma
Medical
Specialty Assessments:
Cardiovascular distress8
Respiratory distress
Altered Mental Status
Obstetrics Assessment
Obstetrics: Delivery
Procedures:
Med Administration
IV Access
Airway Management9
Ventilate Non-Intubated patient10
Endotracheal Intubation11
Team Leader on EMS Unit12
Foot Notes:
1. May be a free-standing ED. However, clinics, urgent care centers, physician offices, etc. may not be substituted.
2. CCU, ICU, CC xport team, Cath Lab, etc.
3. PICU’s, PEDs ED, Pediatrician Office, Peds Urgent Care, Peds Clinic.
4. Prefer L&D unit, but can be satisfied with OB Physician Office or OB Clinic.
5. Use of non-traditional clinical sites is encouraged to allow the student to meet the minimum clinical hour requirements and allow them
to see a variety of patients.
6. The minimum hours/patients/complaints is not meant to equal the total. The minimums must be met in each competency area, but the
student has the flexibility to meet the total.
7. The student should attempt to complete one in each age group: Neonate, Infant, Child, and Adolescent.
8. Cardiac Arrest, Chest Pain/Pressure, STEMI, dysrhythmia, etc.
9. Refer to CoAEMSP interpretation of what constitutes Airway Management “Airway Management Recommendation” in order to
demonstrate airway competency, the student should be 100% successful in their last attempts at airway management.
10. Ventilation may be accomplished utilizing any combination of live patients, high fidelity simulations, low fidelity simulations, or
cadaver labs.
11. AEMT-I: older than 12; Intermediate older than 12; I-P any age group
12. The number in parenthesis is the maximum number of Team Leader calls that can be BLS. The program must establish in writing
what is an ALS call.
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Frequently Asked Questions (FAQs)
1. Is this program affiliated with Tidewater Community College? No, all students who
successfully complete the program will be PDCCC graduates.
2. Can any student enroll in the EMS Intermediate classes (classes listed in the schedule
with the EMS prefix)? No, each student is required to go through a separate application
process to be admitted specifically to the EMS Intermediate Program before he/she can begin
to take EMS classes. Only accepted students can register for EMS classes.
3. What courses should I take in high school? Focus on algebra, biology, and EMT. You will
need to make at least a C+ in these courses.
4. What does your grade point average have to be to get into the program? A curricular
and cumulative GPA of 2.5 or better on a 4.0 college grading scale.
5. What do I need to do to be admitted to the program? Carefully review and follow the
steps described on the second and third pages of this packet.
6. Are there any scholarships or other funds available to help me with school related
expenses? Yes, the college has state and federal financial aid programs as well as several
scholarship programs. Some hospitals have scholarship programs and forgivable loans. You
can discuss your needs with the college’s financial aid office. If you wish to apply for
financial aid or scholarships, you should contact Theresa Harrison at 569-6715 in Franklin or
Marie Linton 925-6307 or 925-6346 in Suffolk.
7. How long will it take me to get through the program? If you have all the high school
requirements and do not need any developmental courses based upon placement tests, and
have had or tested out of computer competencies, it is possible to complete the program in 1
year or 3 continuous semesters. However, there is competition for the slots available and not
all students get in on first attempt. Students will need to reapply the following year if they are
not accepted for the current program year.
8. What degree is awarded? The College awards a Career Studies Certificate in EMS
Intermediate. Upon successful completion of the program students are eligible to take the
Virginia Intermediate Exam and gain certification as a Virginia Intermediate Technician.
9. How old must I be to take the EMS Intermediate course? According to Virginia Law you
must be 18 years of age to enroll in an Advance Life Support Program.
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10. How many days a week and when will I be in school once I begin the EMS courses?
Students will attend minimally 2 days a week – alternating between lecture and clinical
experience. Classes will be scheduled between 6:30 P.M. and 10:30 P.M. On-campus Skills
Labs will operate at during regular class hours. There will be some weekend (Saturday &
Sunday) Classes, but these are minimal and prior notice is given. A class schedule will be
available prior to the start of each semester. Day and times of course offerings may vary in
order to provide for the best possible learning experience. There are also 12 hour clinical
days that students are allowed to schedule at their convenience. The clinical hours and
competencies must be completed before students are marked completed and eligible to take
the certification test. Class schedules are published prior to the start of a course and provide
the day and time of the class offering.
11. How long are the lectures? Lectures will typically be 3 hours per session.
12. Can I take some of the courses while I am still in high school? Yes, if you take EMT in
high school and get a C or better you will get credit for EMS 111 & 120 of the program. If
your grade in high school algebra is a “C” or better AND you score sufficiently high on the
College math placement test (and do NOT score at or below a Math 05 requirement), you
will meet the minimum math requirement prerequisite.
To become better prepared for the rigorous EMS Intermediate curriculum, you can, if your high
school offers these courses, take the following (listed in order of importance):
Dual Enrollment Emergency Medical Technician (EMS 111-120) or EMT
Dual Enrollment Biology (BIO 101-102) or AP Biology
Dual Enrollment English (ENG 111 – 112) or AP English
You will receive college credit from PDCCC (or other community colleges) for the dual
enrollment classes. In most high schools the tuition for these classes is an expense of the student
and his/her family.
Also be aware that high school students 16 and older may enroll in regular community college
courses with appropriate permission from an authorized high school administrator or counselor,
and meet other admission and placement testing requirements as specified by the college.
Among the courses that could be considered in preparation for the EMS Intermediate program
are any of the general education courses in the EMS Intermediate curriculum are EMS 111 and
120 (EMT).
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Be aware that the semester calendars for community college courses are significantly different
from high school calendars, and any student attempting to take regular college courses must
adapt to the college calendar.
13. Will I be able to work and go to school at the same time? It can be done but you must take
into account that being absent too often could result in you not being able to complete the
program.
14. How many credits are required for the program? 27 credits. See page 5 for the list of
courses.
15. If I have a GED, can I still be accepted into the EMS program? Yes. You will need to
take the following mandatory high school courses before you enter the program if you have
not completed them with a C or better: Algebra I, Chemistry, and Biology. If you do not have
credit for those classes, you must take the equivalents in college.
16. Where will my clinicals take place? The hospitals most used will be Sentara Obici in
Suffolk and Southampton Memorial Hospital in Franklin. For pediatric nursing and mental
health/ psychiatric nursing, clinicals will likely be in Portsmouth, Suffolk, Zuni, Newport
News, Norfolk, and Richmond.
17. If you miss a semester for some reason can you come back into the program? Yes, if you
do not stay out for more than a year and you have not withdrawn from or failed an EMS
course twice (2).
18. What happens if you fail a course? If you withdraw from or fail a course one time, you
may request readmission and retake the course. If you withdraw from or fail the course twice,
you will be unable to continue in the program or to be readmitted.
19. How much of my life do I have to give up while in EMS Intermediate school? There are
at least 6 hours of homework per week for EMS classes alone. This does not include library
time or driving time.
20. How much will I have to study? This depends on your learning style and will vary from
student to student. A good estimate would be 6 hours per week for major EMS Intermediate
courses.
21. How many different teachers will I have? You will have a different teacher for almost all
of the general education courses. In EMS Intermediate, you will have up to 5 EMS lecture
instructors and 4-6 clinical instructors over the course of the program.
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22. Will my teachers be certified EMS Intermediates? No. The Virginia Office of EMS
requires that all instructors be a master in their field. The EMS Program requires
documentation from instructors that pertains to their education. You could have a physician
teach one lecture and EMS Intermediate teach another.
23. How much does the program cost? An approximate program cost is subject to change is
$5063.85 for in-state, $7638.25 for out-of-state. The first semester is the most expensive
because of items listed in the next question. If you have to take the full 18 hours in the first
semester, the total cost could be as high as $3,500 in-state depending on whether or not you
have good medical insurance. The lab tests can be very expensive. See page 6.
24. What costs are required? At a minimum you will need to purchase uniforms, work shoes,
laboratory skills supplies, EMS textbooks, CPR course, standardized exams, police
background checks, urine drug screening, physical examination, and laboratory screening
tests.
25. What extra money do we have to anticipate spending? In addition to the already covered
expenses in the page 6 chart, some additional expenses to consider are: gas, car repair, food,
pens, paper and computer supplies, and babysitter to name a few.
What if I have had a lot of traffic tickets? Minor traffic offences are not a problem.
However if you have been convicted of other criminal offences you need to
confidentially speak with the EMS Program Coordinator. Health care facilities require a
criminal background check and urine drug screening and will not allow those with prior
conviction to work in their facilities. However, this does not prevent you from attending
the EMS program. The Virginia Office of EMS has a document titled Prerequisites for
EMS Training Programs, Criminal History and Standards of Conduct which must be
adhered to by any student in an EMS program. The form is available online for review @
http://www.vdh.virginia.gov/OEMS/Training/TPAM/Forms/TR35%20Prereqs%20&%20Conduct.pdf and must be signed on the first day of class.
26. Do I have to volunteer at a fire or rescue department? No. However, it will be beneficial
to you to volunteer and gain field experience while attending the EMS Intermediate program.
It can’t be stressed enough how much participating with an EMS agency could benefit you
throughout this program.
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Application for Admission to the PDCCC EMS Program Deadline: June 19
___________________________________________
Name - Last
First
_________________
Former/ Middle
___________________________
Date of Birth
PDCCC ID#
____________________________________________________________
____________________________
Street
Last 4 SS#
___________________________________________________________
City
State
_____________________________________________________
Email Address Used Regularly
Zip
Home phone
Cell Phone
Work Phone #
PDCCC History: Please answer yes or no
_______ Have you attended Paul D. Camp Community College in the past?
_______Approximately how long ago did you last attend?
_______Have you taken PDCCC placement tests in the last 3 years?
If you have not taken classes at PDCCC within the last three years, you should complete a new Application to the
College and take the placement tests again.
Educational Background
Institution
Level
Location
Attendance/
Graduation/
Completion
Year(s)
Degree/
Major/
Certificate
HS/GED
EMT
# 1 College/
Higher Ed.
#2 College/
Higher Ed.
Proceed to next page
For Office Use
Admission Criteria
Important Course Grades
Proceed to next page
Gen Ed Courses
1. ___Admission to PDCCC
5. ___Completion of prerequisite courses
2. ___Submission of transcripts
___ AHA CPR/ equiv.
___ HS/GED
___ EMT 111 & 120 “C” or better
___ College/ Higher Ed
___ MTH 03 / equiv. “C” or better
6. ___ GPA = 2.5 at least
3. ___ All placement testing
7. ___ Copy of EMT Certificate
4. ___ All dev courses
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GPA or
License
Current?
Previous Work/ Volunteer Experience
JOB
EMPLOYER
Have you previously applied to an EMS Intermediate Program?
Date___________________
Accepted_____
Denied_____
YEARS
Yes_____
No_____
Waiting List _____
Have you previously been admitted to an EMS Intermediate Program? Yes_____
No______
If so, please name school and provide a brief explanation of your status when you left the program.
___________________________________________________________________________________________
Have you ever had a license or certification to practice EMS, revoked, suspended, or otherwise restricted? Explain.
____________________________________________________________________________________________
Is there any reason you might be unable to participate in the EMS Intermediate Program in a safe manner
(illness, use of alcohol, drugs, narcotics, or chemicals)? Explain.
____________________________________________________________________________________________
Have you committed, or been convicted of, any act which is a felony under the laws of Virginia or the United States
or any act which is a misdemeanor under such laws and involves moral turpitude? (Moral turpitude is a legal
concept that refers to "conduct that is considered contrary to community standards of justice, honesty or good
morals). Explain.
____________________________________________________________________________________________
In the space below you may give additional information, which you feel is pertinent to your application. You may
include additional employment history, volunteer work, certificates, scholastic awards, work achievements, and/or
professional organizations. You may attach additional sheets if needed.
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
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Personal References - Arrange to have three people write letters of recommendations for you. All three must
have interacted with you in the past two years however they cannot be a relative. At least one must be an
academic teacher or guidance counselor who has taught/advised you during the last two years. If you have not
attended classes in the last two years, you must include one letter from someone who has supervised you at
your place of work in the last two years. The letters are to be sent to the Nursing & Allied Health Office by
June 19.
Please read carefully the following paragraphs:
I certify that this information is accurate and complete. I understand that giving incomplete or false
information is grounds for denial of the application. I authorize Paul D. Camp Community College to
request such information as necessary to verify my qualifications/suitability for the EMS Program for
which I have applied. I hereby release from all liability or damage those individuals who provide
information related to my education or character and waive any rights of inspection of such information.
EMS students are involved in the provision of direct patient care in medical facilities. Certain medical
facilities require all EMS students to have a Virginia State Police criminal history and sex offender’s crimes
against minors background investigation completed prior to the provision of patient care. Some facilities
may also require drug testing for nursing students. Any student found guilty of a misdemeanor or felony
prior to or during EMS education will be required to request an Exemption from Disqualification from
each of the medical facilities to which they may be assigned during the program. If an exemption is not
granted by the medical facility, the student will be unable to complete the requirements for the EMS
program, and will not be permitted to progress through the program. Students will be required to submit
similar documentation to the Virginia Department of Health Office VDH Office of EMS can deny licensure
to any applicant who has filed false credentials, who has falsely represented facts on the application for
licensure, and/ or who has committed a felony or misdemeanor. In addition, certain health care facilities
may not hire individuals who have committed a felony or misdemeanor.
I understand that the responsibility for providing all transcripts and documentations to the nursing office
lies with the applying student. Failure to provide required documents will be grounds for non-acceptance.
I understand that the following documents are required:
1. Official transcripts from high school or GED scores, colleges, and other higher education facilities
2. Evidence of U.S. citizenship or authorization to reside in the United States
With my signature, I knowledge reading and understanding the information presented on this application
and agree to abide by the requirements specified.
Signature:
Updated 6-1-14 GWG
Date:
15