Mobile Intensive Care Services of Mary Greeley Medical Center 2012 Emergency Medical Technician August 23rd, 2012 – December 15th, 2012 The EMT course is a challenging course that emphasizes the development of student skills in patient assessment and examination, the recognition of signs and symptoms of illness and injury, and proper procedures for rendering emergency medical care. Course content will address broad topics and create a foundation of knowledge and skills preparing students who successfully complete the program for certification testing as a National Registry EMT and State of Iowa EMT. I C SPEC D E I M I AL PAR A Classes will meet on Monday and Thursday evenings from 6 PM until 10 PM at Mary Greeley Medical Center in Ames. Occasional Saturday daytime courses will be included. To successfully complete the course, students will be required to gain clinical experiences with Mobile Intensive Care Services and in the Mary Greeley Medical Center Emergency Department. (Individual student hours may vary depending on the availability of patient contact.) Courses will be coordinated and instructed by professional Paramedic Specialists affiliated with Mobile Intensive Care Services of Mary Greeley Medical Center and other experienced clinicians with specialized expertise. ST Admission Criteria: Students must be at least 17 years of age at the time of enrollment. Students must be functionally able to speak, read and write English. Student must provide proof of health Insurance. Students must be certified in CPR for Healthcare Provider or equivalent by 1/12/2012. Student must provide proof of current immunizations/vaccinations for MMR, Vericella, Tb (or negative Chest X-Ray), Hepatitis B series, and Influenza. I cannot stress this enough… Please make every attempt to bring this documentation to the first night of class. YG M AR CE NT ER RE L EL A EY M EDI C There is no specific application deadline prior to the course, but late applicants will be admitted subject to availability of space in the course roster. Early acknowledgement of special needs and requests for accommodation are appreciated so that efforts can be made to identify the best possible resources for student success. Course Fees: AM Tuition, practical examination fees and the required text: A W ES, I O $900.00 In preparing your course, we make every effort to include all possible expenses and fees in a single figure to provide full disclosure and no hidden costs. National Registry of Emergency Medical Technicians and Iowa Department of Public Health examination and certification fees are not subject to training program control and are paid directly to those organizations following successful completion of the course. Tuition is due on or before January 12th, 2012. Inquiries may be directed to: Course Coordinator, Darin Ruud, Paramedic Specialist Ruud@mgmc.com 515-239-2109 Lead Instructor, Adam Dunlap, Paramedic Specialist Dunlap@mgmc.com 515-239-2109 APPLICATION FOR Spring 2012 EMERGENCY MEDICAL TECHNICIAN COURSE PLEASE PRINT CLEARLY Full Name: ________________________________________ E-Mail: ____________________________________ Mailing Address: ______________________________________________________________________________ City and State: _____________________________________ Zip: _______________________________________ M I C SPEC D E I I AL PAR A Phone: ____________________________________________ Date of Birth: _______________________________ ST Service Affiliation (if applicable): _________________________________________________________________ Describe your healthcare background and any relevant certifications or licenses... CE NT ER YG M AR ____________________________________________________________________________________________ ____________________________________________________________________________________________ Describe why you want to enroll in this program and what you hope gain from it… RE L EL A C E I Y D M E Currently hold an AHA BLS Healthcare Provider card or ARC CPR Professional Rescuer card? Y N ____________________________________________________________________________________________ (If you are currently certified attach a photocopy of your card to this application) AM A W ES, I O If not, a CPR class is scheduled for Wednesday, January 11th from 6 – 10 pm. Reservation is required. I will be attending the BLS for Healthcare Provider Course on 1/10/2012 ($30.00 fee) Y N . Submit this form and any additional relevant documentation to… MICS Education Coordinator Mary Greeley Medical Center 1111 Duff Avenue Ames, Iowa 50010