Emergency Medical Technician (EMT) Course Enrollment

($300 non-refundable deposit)

Note: If an organization is sending you to enroll in our EMT course then, do not complete this form and instead have your organization representative send your enrollment request directly to info@emtacademy.org.

Course Selection

Course Type:	In-person Instructor-led classes with hands-on clinical sessions
Course Duration:	15 weeks
Course Location:	55 Main St., Bldg. B, Ste. 200, Chicopee, MA 01020

Course Start & End Date *

September 5th, 2023 – December 14th, 2023
January 2024 – April 2024

Course Session *

Morning Session: classes meet Tuesday & Thursday 8am – 12 pm for 4 months
Evening Session: classes meet Tuesday & Thursday 6pm – 10 pm for 4 months

PERSONAL INFORMATION

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Cell Phone *

Email *

Date of Birth *

QUESTIONS

Are you Military, Fire, or Police? *

Have you spoken with an admissions specialist? *

How did you hear about EMT Academy Inc.? *

Search Engine (ie. Google, Yahoo, etc.)
Social Media (ie. Facebook, Instagram, YouTube, etc.)
Word of Mouth (ie. Friend, Relative, Co-Worker, etc.)
Advertising (ie. Career Fair, Vehicle Billboard etc.)

Choose all that apply.

Why did you choose EMT Academy Inc.? *

Please provide a brief description of why you choose EMT Academy Inc.

What are your immediate career goals upon course completion? *

Are you interested in having your tuition paid in full through our Bridge Employment Program? *

Policy Attestations

Course Eligibility

In order to be eligible for the state EMT certification, the applicant must be able to:

Read, write, understand, and communicate in English
Be 18 years of age or older
Be free from addiction to alcohol and drugs
Be free from physical, mental defects, or diseases that might impair the student's ability to provide emergency care in the scope of the EMT's training and responsibilities which might jeopardize the health of another member of the class

I have read, understand, and accept the Course Eligibility terms. *

Criminal History

A Massachusetts Criminal Offender Record Information Check (CORI) will be required for licensing by the Massachusetts Office of Emergency Medical Services after successful course completion. As a candidate, you understand that a problematic outcome on this background check may prohibit you from being certified as an EMT by the state of Massachusetts.

I have read, understand, and accept the Criminal History terms. *

Attendance

Students are required to have 100% attendance during their entire EMT course. A student may miss up to two days of class. Students are required to make up all the days they miss. The makeup day fee is $100 per day.

I have read, understand, and accept the Attendance terms. *

Online Learning

This course has an online learning component. Students are required to have reliable internet access as well as access to a laptop, desktop computer, or tablet for the duration of this course.

I have read, understand, and accept the Online Learning terms. *

Grade Average

Students are required to maintain a minimum grade point average of 80% thought the course, as set forth by the Student Handbook. A lower grade point average shall be grounds for dismissal from the course.

I have read, understand, and accept the Grade Average terms. *

Financial Terms

Course Cost

The Total Course Cost of $1,400 is all-inclusive.
Course Cost consists of a $300 non-refundable administrative fee and $1,100 tuition.
Course Cost includes
- Base Tuition, Administrative Fee
- Textbooks, Online LMS
- CPR Certification
- School Uniforms, Student ID Badge
- Background Checks
- Liability Insurance
- Internships
- Practical Exam Fee

Initial Deposit

When reserving a seat in our EMT program, the initial deposit of $300 is a non-refundable administrative fee and may accompany this enrollment application. Seats are filled in the order that deposits are received.
Initial Deposit Payment Options Include: Credit Card ( Am Ex, Visa, Master Card, Discover)
Remaining Tuition May be Paid by
- Cash, Personal Check, Company Check, Bank Check, Money Order
- Employment Bridge Programs

Remaining Balance

The remaining balance of $1,100 must be paid in full on the first day of class unless the student

Is participating in our Bridge Program for employment or
Is exercising our payment plan

Refund Policy

If I terminate enrollment (including voluntary resignation, illness, suspension, or involuntary resignation or dismissal) I understand that I may receive a maxim refund of 30% of the total tuition costs and only if I exit the program within 30 days of the program start date. I understand that I am not entitled to a refund if I am on a payment plan.

Financial Terms Acknowledgement

I understand and agree that I am entering an Emergency Medical Technician training program sponsored by EMT Academy Inc. I agree to pay the Course Cost for the scheduled course and realize that the submission of this enrollment application and non-refundable fee commits me financially to a position in this program. I understand that the card on file will be charged without notice. This is evidenced by my signature on this date and I accept total full responsibility of payment for the program regardless of my status in the program.

Full Name *

Signature *

Today's Date *

Payment Information

Name on Card *

First

Last

Card Address *

Address Line 1

City

State

Zip Code

Card Number *

Card Number

Expiration

Security Code

Checkbox Items *

Non-refundable deposit - $ 300.00

Total *

$ 0.00