Summer/Fall, 2016
This certificate course is intended to introduce individuals with little or no medical background to the discipline of
emergency medicine in the pre-hospital/ambulance setting. Students successfully completing the coursework will be
qualified to take the National Registry of EMTs examination, the test required for Colorado EMT certification. The course is
composed of approximately 190 classroom and skill lab hours followed by approximately 64 hours of clinical time in
approved hospital emergency departments and ambulance services.
REQUIREMENTS:
Submit a completed Application for Admission with the following items by the registration deadline


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



Valid Colorado driver’s license, birth certificate, or valid Colorado ID
Be at least 18 years of age prior to course completion
Proof of high school graduation
Proof of Hepatitis B, MMR and TDAP (tetanus, diphtheria, pertussis/whooping cough, within 7-10 years) immunizations
Current two-step TB test (within 1 year)
CBI name-based criminal background check
Entrance Exam (TABE Test). Testing fee of $40 is payable on day of test

The TABE may be waived for students who meet any of the following:



An Associate’s Degree or higher
ACT or SAT with high scores within the last two years (see catalog page 5 for scores)
Previous completion of a program at DMTC
COURSE COST: $2216.00 for tuition, fees, and required insurance. Books and supplies will be approximately $200, depending on
market prices at time of purchase. Additional fees are required for TABE testing, background checks, NREMT testing, plus any required
immunizations. There is an additional tuition charge for out-of-state registration. Call for information, (970) 874-6540.
REGISTRATION:




Enrollment is limited.
Registration, immunization records and payment are required no later 5:00PM, 4 weeks prior to start of class
Request registration forms and other course information from the Registrar at (970)874-6540.
Questions & additional information: email us at cclymer@dmtc.edu ; phone us at (970) 874-6571.
Class
Dates
EMT, Daytime
(accelerated)
Delta Campus
EMT, evenings
Delta Campus
Winter Classes,
January, 2017
Days
Times
Mon, Wed, Fri
8:30 AM to 5:00 PM
Classroom: Starts May 25, 2016 Ends July 8, 2016
Clinicals end August 22, 2016
6PM-9:3OPM M & W
Classroom: Aug. 29, 2016 – Dec. 16, 2016
Clinicals end 2/23/2016
Mon, Wed, Sat
9AM to 5PM on alternating
Saturdays (1st, 9/10/16)
DELTA: Day/Accelerated , 1/11/17
M, W, F
8:30A-5:P
DELTA: Evening, 1/11/17
M, W, Sat
6:P-9:30P + alt Sat
Paonia: Evenings, 1/16/17
M, Th, Sat
6:P-9:30P + alt Sat
(note possible price increase for fall semester)
We are an equal opportunity educational institution and will not discriminate on the basis of race, color, national origin, sex, age, or
disability, in our activities, programs, or employment practices as required by Title VI, Title IX, and Section 504. For further information regarding civil rights or grievance procedures, contact John Jones, Director of Delta Montrose Technical College, 1765 Hwy 50,
Delta, Colorado 81416, (970) 874-7671, or the Office for Civil Rights, U.S. Department of Education, Federal Building,1244 Speer
Boulevard, Suite 310, Denver, CO 80204-3582, phone (303) 844-5695, FAX (303) 844-4303; TDD (303) 844-3417, or Email
OCR_Denver@ed.gov
Delta-Montrose Technical College
1765 US Hwy 50
Phone: (970) 874-7671
Website: http://www.dmtc.edu
Delta, CO 81416
Fax: (970) 874-8796
1/8/16cc
Email: ems@dmtc.edu
For EMT Courses, Fall & Winter, 2015-16
The Delta Campus Accelerated Day class will start on January 11, 2016. Classes meet on Mondays,
Wednesdays and Fridays from 8:30AM to 5:00PM. The classroom portion lasts for approximately 8
weeks followed by clinical time which must be completed with 45 days of the last day of class.
The Delta Campus Evening EMT class starts on January 11, 2016 and will meet on Mondays and
Wednesdays from 6:00PM to 9:30PM, and every other Saturday from 9:00AM -5:00PM. The
classroom portion of the course lasts approximately 18 weeks followed by clinical time that must be
completed within 45 days of the last day of class.
A Paonia Campus Evening EMT class will start on January 18, 2016, meeting on Mondays and
Thursdays from 6:00PM to 9:30PM, and every other Saturday from 9:00AM to 5:00PM. . The
classroom portion of the course lasts approximately 18 weeks followed by clinical time that must be
completed within 45 days of the last day of class.
There are a few items that each student should attend to prior start of class. Please read the following then
complete and return the required materials. If a student does not already have these materials, they can be
downloaded from our website at www.dmtc.edu . Registration and payment for EMT class must be
complete and submitted no later than four weeks prior to start of the class.
Attached is a registration form to complete and return to the Registrar’s office if not already done. It is best
to bring the registration form in so you can then stop by the Business Office and take care of the financial
arrangements for your class. However the form can be returned by email followed by payment
arrangements. DMTC offers students a deferred payment plan in which the student makes a down-payment
and then develops a payment plan with the Business Office (874-6510) to pay off the balance prior to class
completion.
With the registration form, please submit a copy of your driver’s license or state-issued ID card, a copy of
immunization records ( a separate attachment addresses the details of this), proof of high school graduation,
and a copy of any college transcripts/degrees, to the Registration Department. Once payment or financial
arrangements are complete and registration information is submitted, the student may purchase the textbook
and supplies (a clinical shirt and blood pressure kit) from the Bookstore.
Pre-requisites must be taken care of prior to the registration deadline. Both the Registrar’s Office (874-6540)
and the Business Office (874-6510) are normally open 8:00AM to 5:00PM, Monday through Friday.
Students are required to take a TABE placement test prior to enrollment. This test is to assure appropriate
reading, writing and math skills for this level of class. A TABE waiver is available if the student has 1) a
college degree, 2) has at least 2 semesters of credit at an institution of higher education with a 3.0 or better
grade point average, or 3) has completed ACT testing recently with a 21 or better score in the prior two
years. There is a $40 testing fee payable at the time of testing. Testing can be scheduled through DMTC’s
Testing Center at (970) 874-6505.
Toward the end of the course, students will be released to schedule clinical time at an approved ambulance
service and in an approved emergency department. These agencies have varying requirements for clinical
participation including proof of immunizations and proof of exposure to childhood diseases and in some
cases a urinalysis for drug screening. These medical records and proof of immunizations must be submitted
with registration information and completed prior to admission into the class. A separate handout with the
E M S Program
phone: (970)874-6571
fax: (970)874-6591
email: ems@dmtc.edu
web: http://www.dmtc.edu
forms is included in the pre-course information. Please call the EMS Program office with any problems or
questions at (970) 874-6571.
The EMT course uses on-line resources to support class work, a program called MOODLE. Students should
be familiar with computers and have reliable internet access from home. Please contact the Program
Coordinator if problems or questions. Once enrollment is complete, information will be emailed to the
student to access and complete a one-hour on-line MOODLE orientation class. This is to insure that the
student’s computer is compatible with MOODLE and the student has the navigation skills to complete
required class-work in MOODLE.
A name-check criminal background check is a pre-requisite for those registering for EMT classes. A copy of
that background check must be submitted with the registration forms. Separate instructions to complete this
on-line are included in the registration packet at a cost of approximately $7.00.
The final step to becoming a Colorado EMT after completion of the EMT course is to take and pass the
National Registry of EMTs examination. Students will be given the required registry information near the
end of the class. The same information can be reviewed at www.nremt.org . Colorado and most other states
make this requirement rather than do their own testing. In order to become a Colorado certified EMT after
completion of the course and NREMT testing, the student must apply to the State of Colorado. That
application process requires a fingerprint-based criminal background check through the Colorado Bureau of
Investigation (CBI). The cost is $17.50 to CBI plus any cost by the local sheriff’s department for the fingerprinting. If a student has any concerns about his/her background, specific information on what the State of
Colorado will or will not accept is available on the State’s EMS website at WWW.COEMS.INFO , or at
http://www.cdphe.state.co.us/em/CertificationEducation/certification/CriminalConvictionPolicy.pdf. Any student
with concerns or unanswered questions about background checks can discuss them confidentially with the
EMS Program Director.
A screening interview with the EMS Program staff is required prior to acceptance into the course. This
interview will be scheduled at the student’s convenience. The purpose is 1) for the student to talk face-toface with program staff and ask any lingering questions, 2) to assure that the student understands the nature,
content and requirements of the course, and 3) to assure there are no problems or questions with course prerequisites, medical records, immunizations, TABE, etc.
DMTC tracks information on grants that may be available to assist with EMT tuition costs. Contact us for
additional information, (970)874-6571. Any grants are a separate application process that must be completed
before the registration deadline.
If there are questions or need for further information please call the EMS Program office at 970-874-6571 or
email us at ems@dmtc.edu. All course information and forms are available from our website at
www.dmtc.edu . Any registration materials being returned by email can be sent to admissions@dmtc.edu .
Thank you for your interest in our program, we look forward to seeing you.
Sincerely,
Chan
Channing Clymer, Paramedic
EMS Program Coordinator
6/22/15cc
Z:\Brochures and Flyers\2015\EMT
E M S Program
phone: (970)874-6571
fax: (970)874-6591
email: ems@dmtc.edu
web: http://www.dmtc.edu
SIMPLIFIED CHECK LIST FOR EMT-B ENTRY
Everything on this checklist must be completed and turned in to Jeanne in the Nursing
Department ( jnortrup@dmtc.edu). Plan ahead in gathering the necessary information
as the documentation must be submitted no less than 4 weeks prior to class.
Call Jeanne, 874-6519, if you have any questions regarding the requirements below.
Application: (2 pages)
Background Check: Allow time for processing ( see attached instructions )
Current Driver’s License
2 Step TB tests: Allow 2 weeks for completion
 You will receive 2 shots and two readings and we must have the documentation
on both. Both must be within past year.
Hepatitis B injection:
 This is a series of 3 shots. You may have already had this series… we must
have the documentation.
T-Dap: within past 7-10 years) Tetanus, Diphtheria, Pertussis
MMR: documentation of two doses or titer: (Measles, Mumps, & Rubella)
Flu shot: (This must be done for the flu season and will be required for
clinicals being done between October 1st and May 1st )
High School Transcript
H
i
g
h
Letter of Interest and Intent: a letter from the student to the EMS Program
Coordinator, explain why he/she is enrolling in this course (career goal,
volunteer fire/ems, required for work, healthcare-related education goal)
TABE Test:
 This is by appointment only. The testing center is open on Tuesday & Thursday
only. Please call for an appointment (970)874-6505.
 You must pass all sections of the test with an 11.9 or greater.
 Waived if ACT scores of English 18, Reading 17 & Math 19 or a college degree.
Student Health Disclosure Form
Moodle Orientation
Authorization for payment if being sponsored by 3rd party
Delta-Montrose Technical College – EMS Program
(970)874-6571
ems@dmtc.edu
EMT Registration / Jeanne: (970)874-6519
jnortrup@dmtc.edu
Delta-Montrose Technical College, EMS Program, (970)874-6571
DMTC requires a background check on all enrolling EMT students. The instructions below describe how
to go on-line and get a back ground check from the Colorado Bureau of Investigation, at a cost of $6.85.
On completion, it will be emailed to you, within minutes of your submission and payment. You can print
it and include it with your application. The student has the option of having it sent direct to DMTC.
Please note, this is a name-check only. This background check will not take the place of the fingerprintbased background check required for State certification as an EMT, after completion of the EMT course
and National Registry testing. The Colorado EMS website lists information regarding criminal
background – it can be accessed at the following web address, cut-n-paste it into your web browser:
http://www.cdphe.state.co.us/em/CertificationEducation/certification/CriminalConvictionPolicy.pdf
INSTRUCTIONS FOR ON-LINE BACKGROUND CHECK
1.
2.
3.
Go to www.cbirecordscheck.com
Click on “individual search”
Click on “conduct an individual search without setting up an account”
Note the cost of $6.85, to be paid by credit card. Note that if there is an error in what you input, or if
there is another person with your same name and ssn, you may have to pay for a second search. Make
sure your information is complete and accurate (your full name spelled correctly, correct date of birth,
correct social security number, etc).
4.
5.
6.
7.
8.
9.
Check the “I have read and agree” box and then click on “continue”
Fill in all the information on the next page. Even though it will allow initials for a middle name, I
suggest you use your full name to avoid any errors. Click the “reason” drop-down, then click on
“emergency medical technician”, then click on “continue”.
The next page is so you can proof the information you have entered. If it is correct, then click
on continue.
On the next page, “user Information” is who you wish this report to be sent to. You can send it
to yourself, print it and include it with your application. Or, you can have it sent direct to the
EMS Program at DMTC:
cclymer@dmtc.edu ;
DMTC, atten Chan Clymer
1765 Highway 50, Delta, CO 81416; (970)874-6571
Next section: The billing information must be filled out to match information on the credit card
account you are using. Then below that is the actual credit card information. If all items in
these two do not match the credit card records, it will not process. When you are ready to click
on “continue”, note the statement you are approving, that under penalty of perjury, you swear
that the information you have put in is correct. Click on “continue”.
The next screen up, which may take seconds or a few minutes, will be the actual record check.
You can print it, save it, etc. If you put DMTC’s email above, it will be emailed to us at the same
time.
Please call us if you have problems or questions. Note that if you are working on this over weekends or
holidays, we often respond better to email than to phone. cclymer@dmtc.edu ; (970)874-6571
“Where Careers Begin”
Application for Admission
Submission of this application does not
constitute registration for classes.
1765 US HWY 50 DELTA, CO 81416
Instructions: Please enter your name exactly as it appears on official documents (i.e. driver’s license).
Phone/Address
Personal Information
Please use black or blue ink and print legibly.
Legal Name:_________________________________________________________________________
Last
First
Middle
Suffix (Jr, II)
Gender
Female
Maiden Name (or other):_______________________________________________________________
(if applicable)
Male
Are you registered with the
selective service? Yes No
Social Security #:__________________________ Birthdate:_____/_____/_____
Email:_____________________________________________________________
Local (mailing) Address:__________________________________________________________________________________________________
Street
City
State
Zip Code
Permanent Address:_____________________________________________________________________________________________________
(if different from above)
Street
City
State
Zip Code
Home Phone:___________________________
County:________________________________
(Mailing)
Cell:_______________________________
Work:_________________________________
County:________________________________
(Permanent)
Ethnicity/Race
(for Federal Reporting Only)
Citizenship Status
Ethnicity- Select One
US Citizen
Hispanic/Latino
US Permanent Resident
Not Hispanic or Latino
Alien Registration #______________
Other Citizenship
Race-Please select all that apply
(Visa Type:__________________)
American Indian or Alaskan Native
Country:_____________________
Asian
**You must attach a copy of your I-551 (Resident Alien Card--both
Black or African American
sides) or I-94 (Arrival Departure Record). If you are under the age of
Native Hawaiian or other Pacific Islander
23, you must attach a photocopy of both you and your parent’s/legal
White
guardian’s I-551 or I-94.
1. Are you at least 23 years old?
Yes
No
2. Are you under 23 years old and have been married more than 1 year?
Yes
No
3. Are you under 23 years old and have never been married?
Yes
No
4. If you answered yes to questions 1 or 2 put your name on this line. If you answered yes to question 3, a parent or guardian’s name goes on this
line: ____________________________________________________
Residency
The following questions pertain to the person named on the line in question 4 and are used to determine Colorado residency for
tuition classification.
5. Has the person lived In Colorado for the last 12 months?
6. Has the person been employed in the state of Colorado for the last 12 months or more?
7. Will this person file Colorado taxes this year?
8. Did this person file Colorado taxes last year?
9. Has this person been registered to vote in the state of Colorado for the last 12 months or more?
10. Do you have a SASID (state assigned student identification)?
11. Have you or the person named above registered a motor vehicle in Colorado in the last 2 years?
If yes, license plate #:_____________________________________
For the person listed in question 4, please provide a current Colorado driver’s license or ID# and expiration date:
#____________________________________________________Expiration Date:_____/_____/_____
We will need a copy of the student’s driver’s license or photo ID at the time of registration.
Last Revision 2/16/15
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
No
No
I want to take the following Community Education/EMS Course:________________________________________________________________________
If you are taking a Community Education course or an EMS course you may skip to the signature portion of the application below.
Enrollment Data
Do you consider yourself economically disadvantaged?
Yes
Yes
Is English your primary language?
How did you hear about DMTC?
No
Please select all that apply.
 Radio
 Television
 Counselor
 Newspaper Ad
 Driving by/Sign
 Received Schedule in Mail
 Email
 Website
 Friend/Family Member
 High School
 Phone Book
 Other___________________________________
(Please Explain)
__________________________________________
No
If no, what is your primary language? ______________________________
Do you consider yourself a displaced homemaker?
Yes
No
Do you consider yourself a single parent?
Yes
No
Which best describes your current status?
Year and semester I plan to attend
 Re-entering--former student at this institution
 Transfer, attended another college
 New Student, first college attended
Year: 20_____
Semester
 Summer (June, July, August)
 Fall (Sept. Oct. Nov. Dec.)
 Spring (Jan. Feb. Mar. Apr. May)
 High School Diploma
 G.E.D.
 Certificate
 Associate’s Degree
 Bachelor’s Degree
 Master’s Degree
 Doctorate
Date received_____/_____/_____
Date received_____/_____/_____
Date received_____/_____/_____
Date received_____/_____/_____
Date received_____/_____/_____
Date received_____/_____/_____
Date received_____/_____/_____
Name, city and state of last high school you attended:
______________________________________________
I plan to enroll in the following course of study:
College Plans
Education
Which best describes the level of education you have
completed?
(Choose One)
______________________________________________
Name, city and state of last college you attended:
______________________________________________
______________________________________________
 Automotive Technician
 Barbering
 Business
 Administrative Support Specialist
 Bookkeeping Technician
 Bookkeeping/Office Technician
 Graphic Design for Business
 Graphic Design Fundamentals
 Computer Information Technologies
 Cosmetology
 Law Enforcement
 Early Childhood Professions
 Emergency Medical Services
 EMT-B
 EMT-I
 EMR
 Esthetician
 Hairstyling
 Massage Therapy
 Nail Technician
 Nurse Aid (CNA)
 Practical Nursing
 Technical Drafting (CAD)
I hereby certify that, to the best of my knowledge, the information furnished in the application is true and complete without intent of
evasion or misrepresentation. I understand that if it is found to be otherwise, it is sufficient cause for rejection or dismissal.
_________________________________________________________________________________________________________________
_
X Signature
X Date
Equal Opportunity/Affirmative Action
Delta-Montrose Technical College is an equal opportunity educational institution and will not discriminate on the basis of race, color, national origin, sex, age, disability, in our activities, programs, or
employment practices as required by Title VI, Title IX, and section 504. For further information regarding civil rights or grievance procedures, contact John Jones, Director of DMTC, 1765 US HWY 50,
Delta, CO 81416, (970) 874-7671, or the office for Civil Rights, U.S. Dept. of Education, Federal Building, 1244 Speed Blvd., Suite 310, Denver, CO 80204-3582; phone (303) 844-5695, FAX (303) 8444303, TDD (303) 844-3417, or Email OCR_Denver@ed.gov.