Paramedic Course Application
2014-2015
Revised:
2/12/2014
TO:
FROM:
RE:
Paramedic Science Program Applicants
Leon Bell, Program Director
Information and Application Packet
The Eskenazi Health/IEMS Paramedic Program will be approximately twelve (12) months
in duration. Classes are scheduled twice a week; Monday or Wednesday for Day 1, and
Thursday or Friday for Day 2. Each week can vary on which Day 1 and Day 2 you attend.
Classes are from 9:00 a.m. to 5:00 p.m.
The program is divided into three (3) domains which are graded in each segment of the
program: didactic, psychomotor, and affective.
The following information will be helpful in completing the Eskenazi/IEMS Paramedic
Science Program Application process.
 Prerequisite Certifications and College Courses Needed
 Application
 Anticipated Expenses For Program
PREREQUISITE CERTIFICATIONS AND COLLEGE COURSES NEEDED
1. Each applicant must have a current EMT certification.
2. Each applicant must have a current CPR certification.
3. Each applicant must have a college level English and Math class, with a grade of “C”
or better.
4. Each applicant must also have 6.0 hours of Anatomy and Physiology.
5. If an A & P course is needed, IEMS has an online course available at no charge.
6. If an applicant does not have any transcripts, he/she must take the FISDAP
Paramedic Entrance Exam (www.FISDAP.net). Create an account and take the
Entrance Exam. There will be a fee charged by FISDAP for this test.
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APPLICATION
Eskenazi Health/
Indianapolis Emergency Medical Services
Paramedic Science Program
APPLICATION for ADMISSION
Date:
I am applying for program admission in:  January
 August
 I have no preference
Personal:
NAME Last
First
M.I.
EMAIL ADDRESS (Current and read on a regular basis)
ADDRESS
CITY
PHONE (Home)
STATE
ZIP
COUNTY
CELL PHONE
SSN
DOB
EMERGENCY CONTACT NAME AND RELATIONSHIP
EMERGENCY CONTACT NUMBER
DRIVERS LICENSE NUMBER
CPR CARD (Circle One):
EXPIRES:
Yes
No
/
/
EMT CERTIFICATION NUMBER (Provide one copy)
INITIAL DATE OF CERTIFICATION
CERTIFICATION EXPIRATION
DATE
/
/
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CURRENT EMS PROVIDER – include station and or
assignment
SHIFT
NUMBER YEARS AT CURRENT EMPLOYMENT:
Educational Background:
Educational institution
High School:
Term of
Entrance
Term of
Departure
Degree
Received
Previous Institution(s):
Current Institution(s):
ANTICIPATED EXPENSES FOR PROGRAM
Tuition:
$6,600.00
Tuition is due on the first day of class, unless other arrangements have
been made.
Textbooks:
$554.95 for electronic version of textbook plus cost of “IPad” or
computer device/laptop.
FISDAP Fees:
$164.00 (for scheduling and skills tracking during course)
Malpractice
Insurance:
$165.00
Criminal
Background:
$100.00
Drug Test:
$90.00
National
Registry Exam:
$110.00
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Refunds:
Students submitting written requests to withdraw for the course prior to the following
dates for any reason may receive a refund as follows:
1.
2.
3.
4.
5.
6.
Refunds and Course Exchanges
(9 + weeks of instruction)
Students dropping courses prior to the end of the first week of classes will receive a
100% fee credit for the courses dropped.
An additional Late Program Change Fee (service charge) will be assessed beginning
in the second week of the classes for any course changes.
Students performing any exchange of courses in the second week of classes will
forfeit 25% of their fees for the dropped course. A 75% credit will be applied
toward the fees for the added course.
Students performing any exchange of courses in the third week of classes will forfeit
50% of their fees for the dropped course. A 50% credit will be applied toward the
fees for the added course.
Students performing any exchange of courses in the fourth week of classes will
forfeit 75% of their fees for the dropped course. A 25% credit will be applied
toward the fees for the added course.
Students performing any exchange of courses after the fourth week of classes will
forfeit 100% of their fees for the dropped course.
No refunds will be given for textbooks, computer devices, FISDAP fees, or malpractice
insurance.
The student is responsible for all additional costs. No personal checks will be accepted for
tuition; cash, money order or cashier’s check will be accepted.
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