Emergency Medical Services
Summer Boot Camp
Dear Applicant:
Thank you for showing interest in the EMS Boot Camp 2016 scheduled for June 13, 2016 to June 24, 2016. Attached to
this letter you will find the necessary forms to apply for the Boot Camp. This letter explains the application criteria,
procedures and important dates that you need to be aware of in order to successfully apply for the Summer Boot Camp.
Criteria
1) The applicant must be an incoming 11th or 12th grade student, in good standing, in a San Bernardino County High
School; and 2) Must receive a recommendation from a primary teacher or counselor.
Procedures
Complete all items in this application packet as directed:
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Application: The application form must be completely filled out. Be sure that both parent and student signatures are
present. Incomplete applications or those submitted after the application deadline will not be considered.
•
Career Essay: The essay prompt is attached. You should provide two copies of your essay.
•
Information Sheet: Must be filled out and attached to your application.
•
Recommendation Letter: You will need 2 recommendation letters either from your primary teacher(s) or counselor(s).
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Teacher(s)/Counselor(s) Evaluations: You will need 2 evaluation forms. Be sure to give your evaluation forms to
either a high school teacher(s) and/or your counselor(s). Give teacher(s)/counselor(s) an envelope for your
recommendation letters to be sealed in. You should pick up the recommendation letters from your
teacher(s)/counselor(s) and submit them with a complete packet.
•
The application form, one of your career essays, information sheet, recommendation letter and teacher(s)/counselor(s)
evaluations should be stapled together and this packet along with the second copy of your essay should be returned to
your school’s career center by Friday, May 20th before 3:00 pm.
Important Dates
The following are important dates for EMS Boot Camp application process:
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Applications available from the school’s counselors beginning April 29, 2016.
Application deadline: Friday, May 20, 2016 by 3:00 pm students should return applications to the Counseling
Office.
All applicants will be notified by email on the 27th of May 2016.
Emergency Medical Services
Summer Boot Camp 2016 Application
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PERSONAL:
Name: _____________________________________________________
M or F (circle one)
Address: __________________________________________________________________________
City: _________________________ Zip: _______________ Home Phone: ___________________
E-mail ______________________________ Social Security Number __________________________
Student Number: _____________________________
CDL Number: __________________________
Birthdate: _______________________ Age: ________ Height: ________ Weight: _______
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PARENT / GUARDIAN INFORMATION:
Name: _______________________________ Address: ____________________________________
City: ________________ Zip: _________ Home Phone: _____________ Work Phone: __________
Name: _______________________________ Address: ____________________________________
City: ________________ Zip: _________ Home Phone: _____________ Work Phone: __________
************************************************************************************
EDUCATION / EMPLOYMENT INFORMATION:
Current School: ________________________________ Counselor: __________________________
Are you employed? Y or N (circle one)
If yes, Employer: _______________________________
Address: ______________________________________ City/Zip: ___________________________
Job Title: ______________________ Phone: _________________ How many Hours/Week? ______
Do you speak any foreign languages? Y or N (circle one) If yes, which one?
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I understand that the above information will be used for EMS Summer Boot Camp purposes only and
will not be released to any other person or agency.
__________________________________
Parent/Guardian Signature
______________________________
Student Signature
_____________
Date
Emergency Medical Services
Summer Boot Camp 2016 Essay Prompt
EMS Summer Boot Camp Mission Statement:
To provide students in High School an opportunity for hands-on
experience in the work of Emergency Medical Services, to begin their
post-secondary education,
and to prepare them for these professions.
Write an essay (minimum two pages, typed in Times New Roman
12 point font, double-spaced, using one-inch margins or the
closest default margins on the computer you are using) that
demonstrates proper writing skills and addresses all the
following questions in a coherent, well-organized, and thoroughly
developed explanation. Be sure to label your essay with your
name, your school, and the date.
•
•
•
•
•
•
•
•
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When did you begin to develop your career goals?
What persons were most influential in your thinking about the
future?
What have you learned or done so far in life that relates to the
EMS Summer Boot Camp Mission Statement?
What profession do you ultimately want to pursue?
What do you expect to learn from the EMS Summer Boot Camp
experience that will help prepare you for your future?
Why is being in the EMS Boot Camp important to you?
What attributes or qualities will you bring to the EMS Boot
Camp?
EMS Boot Camp participants are expected to have excellent
personal integrity, which includes qualities such as honesty,
dependability, reliability, loyalty, and a strong work ethic.
Explain examples of ways that you have demonstrated integrity
already in your life.
Why should we choose you for the EMS Boot Camp?
DEADLINE: Before 3:00 p.m. Friday, May 20, 2016 Counseling Office.
CRAFTON HILLS COLLEGE
INFORMATION SHEET
Confidential Information
Print Information Legibly
Date: ____________________________
Course Title: ________________________
Name: _______________________________________________________________________
(First)
(MI)
(Last)
Mailing Address: ______________________________________________________________
City: _____________________________
Home #: _______________
State: _______
Work # : _______________
Zip: _____________
Cell #:_________________
Email ______________________________
Nicknames: __________________________________________________________________
Age: ______________________
Hobbies:______________________________________________________________________
Goals or ambitions: ____________________________________________________________
Why are you taking this course? _________________________________________________
Recommendation Request for (Teacher) ____________________________________________________
EMS SummerBoot Camp
Teacher Evaluation Form
Student Name ____________________________________________________________
The above named student has applied for admission to the EMS Summer Boot Camp
2016. We would appreciate your true evaluation of this student’s abilities. To ensure
confidentiality, please place the completed form in an envelope, seal, and return to the
student. Thank you!
RATING: Please circle the phrase that best applies in each section below:
Relations
With Others
Attitude/
Application to
Work
Judgment
Dependability
5
Exceptionally
well accepted
Outstanding
in enthusiasm
4
Works well
with others
Very interested
and industrious
3
Gets along
satisfactorily
Average
in motivation
2
Has some
difficulty
Somewhat
indifferent
1
Works poorly
with others
Very indifferent
and apathetic
Exceptionally
mature
Above average
in decision
making
Above average
in dependability
Usually makes
the right
decision
Usually
dependable
Consistently uses
bad judgment
Learns quickly
Average
in learning
Average
Average
Often uses
poor
judgment
Often
neglectful or
careless
Rather slow
to learn
Below average
Below average
Completely
dependable
Ability to Learn Learns very
quickly
Quality of work Excellent
Attendance
Excellent
Very good
Very good
Unreliable
Very slow
to learn
Very poor
Very poor
Comments/Remarks:
Signature of Teacher: _____________________________________ Date: ___________
Thank you for your time and consideration!
For office use only: Evaluation point total _________________________________________________