Hill College
Emergency Medical Services Professions
Application Procedure
Emergency Medical Services Professions (EMSP)
Fall Entry 2014 Cleburne Paramedic Class
Day - C Shift / Night - B Shift
Application Deadline: July 14, 2014
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The Health Science departmental application packet will be available on the departmental website
http://www.hillcollege.edu/academics/Technical/Health_Sciences/EMS.html or in the Health Science Department.
Email: Sarah Rost 817-760-5935 srost@hillcollege.edu Or Julie R. Britton 817-760-5921 jbritton@hillcollege.edu
- Please include EMS Application request in the subject line
After submission of the completed packet the applicant will be given the HESI A2 with Critical Thinking Referral
form. The applicant must have the completed referral form at the time of their scheduled HESI A2 with Critical
thinking test.
The applicant must read the general admission criteria packet for further requirements for the possible selection in
the next scheduled Paramedic Program. You can find a link to this packet at the following website
http://www.hillcollege.edu/academics/Technical/Health_Sciences/EMS.html or in the Health Science Department.
 **TESTING NOTES**:
 **You must contact the Hill College Testing Center to schedule
 ** The Hill College testing center will not schedule appointments after noon on the last
day of the testing block.
 **You may only take the HESI test 2 (two) times in an application/testing block.
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Testing Center contact information: Hillsboro 254-659-7815
Cleburne 817-760-5815
Incomplete application files will not be evaluated.
Documents and/or files will be purged after 1 year excluding the following:
o Course evaluations
o Course waivers
o Transcripts
Candidates who are enrolled in one or more of the pre-requisite courses and/or incomplete files will be
considered for acceptance at a lower priority than candidates who have completed the application process as
well as completed the pre-requisites with a “C” or better by the admission deadline date.
Submission of this application packet does not guarantee admission/selection in the
Emergency Medical Services Professions program.
EMS Professions Coordinator/Director:
Diedra R. Blankenship, LP, EMSAC, BSEHS2112 Mayfield Pkwy Cleburne, TX 76033
(817) 760-5929 dblankenship@hillcollege.edu FAX: (817) 760-5930
Paramedic Admission Packet 1
Hill College
Emergency Medical Services Professions
Pre-Entrance Information Sheet
Full Legal Name: _________________________________________________________________
Mailing Address: _________________________________________________________________
City ___________________________ Zip ___________
Email address: __________________________________________________________________
Phone
Home __________________ Cell
__________________
Hill College Student ID _____________________________________________
High School/GED ______________________________________________
EMT-Basic completion date: __________ College attended:____________________ Year________
*Texas State Certificate number: _____________
*Refer to admission requirements for further information.
List below any licenses/certifications or health-related credentials you currently hold.
_________________________________________________________________________________________________
_______________________________________________________
List below other EMS or health-related programs attended, with locations and date.
_________________________________________________________________________________________________
_______________________________________________________
List below the names/addresses/phone number of the last three employers (including present) and date of employment:
1. __________________________________________________________________________
2. __________________________________________________________________________
3. __________________________________________________________________________
Of the three (3) classes below please list the college attended, year, and grade received or note you are currently enrolled.
1. BIOL 2401 A & P I_____________________________________________________________
2. BIOL 2402 A & P II____________________________________________________________
Please list other college hours you have completed with the name of the institution, and year attended.
Use the back of this form if you need more room.
1. _________________________________________________________________________
2. _________________________________________________________________________
Signature: _________________________________________
Date: ______________
Paramedic Admission Packet 2
Health Science
(EMS: Paramedic)
Student Information Data Sheet
Please print the following information:
Last Name
Middle Name
First Name
Maiden Name
Suffix (Jr. III)
Please list other names you have been known by: _________________________________________
__________________________________________________________________________________________
________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
_______________________________________________________________
Date of Birth: ______\______\_______
Social Security #: _________\_______\_________
Driver’s License #: ________________________
State Issued: ___________ Expires: ________________
Height: ________ Weight: __________ Gender (M or F): _______
Ethnic Group: __________
(1=White 2=African American 3=American Native/Aleutian 4=Asian/Filipino 5 = Hispanic 6=other) (Enter
appropriate number)
Natural Color of Hair: _________________ Color of Eyes: ____________
CITY/STATE or COUNTRY of Birth: ____________________________
Paramedic Admission Packet 3
Hill College
Emergency Medical Services Professions
I _____________________________acknowledge that I have received the following documents:
Please initial each section below denoting that you have read the related policy:
______ Acknowledgement of Background Check and Drug Test
_____ Immunization Acknowledgement
_____Point System Policy
By my signature below I acknowledge that I have received a copy of the above stated documents and understand the rules and
regulations regarding the criminal background/drug testing requirements as stated in the above documents.
___________________________________________
____________________
Candidate Signature
Date
Paramedic Admission Packet 4
Hill College
Emergency Medical Services Professions
Acknowledgement of Background Check and Drug Test
___________________________________________________
Prior to Enrollment for Hill College EMS Professions: Criminal Background and an 11 panel drug test must be
completed.
11 Panel Drug Test: Amphetamines, Barbiturates, Benzodiazepines, Cocaine Metabolites, Marijuana,
Methadone, Methaqualone, Opiates, Oxycodones, Phencyclidine, Propoxyphene. The preferred testing site is:
realPerformance (former Cleburne Physical Therapy) 1014 N. Nolan River Road Cleburne, TX 76033 Phone: 817-6418617 ~$42.00 ***all other sites must be pre-approved by EMS Professions Coordinator
Texas Department of State Health Services
RULE §157.37 Certification or Licensure of Persons with Criminal Backgrounds
Link:
http://info.sos.state.tx.us/pls/pub/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&ti=25&ch=157&rl=
37
Clinical facilities have the right to refuse any student to attend clinical rotations at their facility for any issue related to an
eligibility issue. If this occurs, the student will not be able to continue in the EMS program.
Failure to disclose a potential eligibility issue not found by the Hill College EMS Professions will be considered unethical
behavior and will constitute dismissal from the program without cause.
“Hill College policy prohibits the unlawful manufacture, possession, use, sale, transfer, or purchase of a controlled
substance or designer drug on campus. It is also a violation of College policy for anyone to unlawfully possess, use, or be
under the influence of an alcoholic beverage or controlled substance on the campus or a College related activity offcampus”
If drug test comes back positive, student will not be allowed to register for the EMS Professions. The student further
acknowledges that at any point within his/her educational experience the student may be required to do further drug testing
and/or background checks if the program director in consultation with the instructor(s) feel there is sufficient evidence to
warrant further investigation.
Hill College has partnered with Verified Credentials to manage your Background Check:
To access Verified Credentials – Student go to: http://scholar.verifiedcredentials.com/hillcollege
How It Works:
1. Enter code for the program you will be attending located above the “Get Started!” button on the right side of
the page
2. Create an account
Health Sciences and EMS Program
3. Enter all required information
BBKPC-26727
4. Provide supporting documentation
5. Track your progress
6. Information will automatically be shared with your school
If you have any questions, our Client Services Team is ready to assist you. Please call us at 800.938.6090 or email us at
ClientServices@verifiedcredentials.com.
Paramedic Admission Packet 5
Hill College
Health Science
Immunization Acknowledgement
All current Hill College Health Science students.
It will be the students’ responsibility to maintain the immunization requirements throughout their
educational process. Any break in the immunization requirements will result in the student being unable to
attend the scheduled clinical rotations until the requirement is updated and on file with the Hill College Health
Science Department.
Student(s) who do not have or do not maintain a current seasonal Influenza (Oct. – Sept.)
throughout their educational process will not be guaranteed a clinical site.
The Hill College Health Science department must adhere to the clinical facility policies and
procedures regarding all immunizations. Students may be denied entry or will be required to wear a
mask during their clinical rotations, per that clinical site policies and procedures.
Required Immunizations:
a.
b.
c.
d.
e.
f.
Flu Shot for current flu season
MMR 1 & 2 OR MMR Titer showing immunity
TDap (within Adult Lifetime)
Varicella 1 & 2 OR Varicella Titer showing immunity
HEP B 1, 2, & 3 OR HEP B Titer showing immunity
TB
After Enrollment:
Student(s) also required to complete: Paramedic Pre-Enrollment Health Screening
Link: http://www.hillcollege.edu/academics/Technical/Health_Sciences/EMS.html
Paramedic Admission Packet 6
Hill College
Emergency Medical Services Professions
Point System Policy
In addition to the general admission requirements to Hill College, the Hill College EMS
Professions implemented (Fall 2011) a point system for possible acceptance in the EMS Professions.
Required:
1.
HESI Testing (Math 60%, Reading 70%, A&P 60%, Critical Thinking 700)
2.
Preparation Questionnaire
Submit Questionnaire form supplied during HESI Testing (neatly handwritten) .
The essay needs to include:
A. Your strengths
B. Your Weaknesses
C. What preparations have you made?
D. Your goals
E. Why you are the best candidate?
F. Why you are interested in Emergency Medical Services as a career?
3. Reference form
1.
Professional: (current/former supervisor, co-worker Or instructor/counselor only, not from
friends or family members)
2.
No References: no points will be given for references not received by deadline or received from
unacceptable source or method of delivery
NOTE: All references must be mailed. The EMS Professions will not accept faxed or hand delivered
references.
NOTE: You must show that you have completed the pre-requisite EMT-Basic courses with a “C” or better.
Candidates enrolled in the pre-requisite may be considered for acceptance at a lower priority than
candidates who have completed the pre-requisites by the admission deadline date. If you need
further clarification on this requirement please contact the Program Coordinator.
NOTE:
If employed as an EMT Basic/intern you must submit copy of your state certificate along with a
letter (must be on letterhead) from your current employer stating you have worked greater than six
months in your field of study.
The following are not required but may be considered:
*To receive 1/2 of the points you must submit a student copy of your transcript showing you have completed
with a “C” or better, are currently enrolled, or a letter (on letterhead) from the institution you are attending
detailing your status as a student.
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BIOL 2401 Anatomy & Physiology I
BIOL 2402 Anatomy & Physiology II
ENGL 1301 English Composition I
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ENGL 2311 Technical Writing
PSYC 2301 General Psychology
BCIS 1305 Business Computer Applications
Paramedic Admission Packet 7