Allied Health Programs - Request Information

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410.822.5400 · TDD 410.827.9164 · P.O. Box 8 · 1000 College Circle · Wye Mills MD 21679

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Allied Health - EMS

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EMS Home
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EMS Programs

EMS - Paramedic (AAS)
EMS - Paramedic (Certificate)
EMT - Paramedic (Certificate)
CRT (Letter of Recognition)

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Allied Health Programs

Use this form to request more information on the Allied Health programs we offer.

Name/Address/Phone

First Name:
Last Name:

Address:

City, State, Zip:

Phone:
Best time to call?

Email:

Date of Birth (mm/dd/yy):

Education

Are you currently attending Chesapeake College? Yes No

Have you previously attended Chesapeake College? Yes No

Have you attended any other college/university? Yes No

Have you taken placement testing at
Chesapeake College or any other college? Yes No

I'm interested in (please check all that apply)

EMS - AAS Degree
EMS - Certificate
EMT-P - Certificate
Cardiac Rescue Technician
Surgical Technology

Massage Therapy
Radiological Science
Phlebotomy
Physical Therapist Assistant
Histotechnology
Nursing

Please send information via
regular mail to address above
email
both

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Chesapeake College · P.O Box 8 · Wye Mills, MD · 410-822-5400