This form is for applying to the Chesapeake College EMS Program. Admission to the EMS Program is limited, therefore, selection is competitive. Please note that the application period is from January 15 through March 31.

Complete applications are the responsibility of the applicant and necessary for consideration for admission to the program.
Please note that you may save your progress on the application at any time and come back to it by clicking “Save Draft” at the bottom of this page.

Questions? Please contact Mr. Jon Longest at [email protected], or at 410-822-5400 ext. 2724.

APPLICATION CHECKLIST – All of the following must be completed in order for your application to be complete:

Complete a Chesapeake College general application.
General applications can be found at www.chesapeake.edu/admissions/credit.

Complete the EMS Program specific application (below).

Submit copies of high school diploma, or GED certificate, and college transcripts.
Upload below an official copy of your high school transcript or GED certificate.
Upload unofficial college transcripts below, and request official college transcripts from all colleges attended be sent to the Chesapeake College registrar. (Chesapeake College transcripts do not need to be requested.)

Submit your current EMT card (Maryland or National Registry).

College Readiness Assessments are required unless the applicant is exempt.
Find exemption information at www.chesapeake.edu/admissions/credit/placement-testing/. (This page also contains the directions for scheduling these assessments.)
Upload results below.

Submit verification of EMT Experience
Have your department run the “Crew Members EMS Incident Participation” report in Image Trend (eMEDS). Change “Incident Date” for a 5-year period (or less if not an EMT for 5 years). Select “incident crew member full name.” May need to select “is equal to” to find name, then change the modifier to “contains” and delete middle name for the report to run.
Upload report below.

Request submission of EMS Program Applicant Evaluation form.
Two company level supervisors must complete this online evaluation form. In the meantime, applicants should complete their application form below – please don’t wait!

 

Application: Emergency Medical Services Program

EMS Application

EMS Application

Contact Information

Name
Name
First
Last
Address
Address
Street address
(PO, apt, etc)
City
State/Province
Zip/Postal
MM/DD/YYYY

Education

Maximum file size: 5MB

Upload official copy of your high school transcript or GED certificate. Allowed file types: gif, jpg, jpeg, png, pdf.

Maximum file size: 5MB

Upload unofficial college transcripts here. Official college transcripts from all colleges attended should be sent to the Chesapeake College Registrar. (Transcripts from Chesapeake College do not need to be requested.) Allowed file types: gif, jpg, jpeg, png, pdf.

College Readiness Tests

Check if exempt from ALL Readiness Tests
For more exemption information, visit Chesapeake Admissions Accuplacer

Maximum file size: 5MB

Allowed file types: gif, jpg, jpeg, png, pdf.
Passing score is 237-249
MM/DD/YYYY

Maximum file size: 5MB

Allowed file types: gif, jpg, jpeg, png, pdf.
Passing score is ≥ 4.
MM/DD/YYYY

Maximum file size: 5MB

Allowed file types: gif, jpg, jpeg, png, pdf.
Passing score is 252-271.
MM/DD/YYYY

Maximum file size: 5MB

Allowed file types: gif, jpg, jpeg, png, pdf.
Passing score is 5-8
MM/DD/YYYY

Maximum file size: 5MB

Allowed file types: gif, jpg, jpeg, png, pdf.

EMS and Fire Department Membership

Name of EMS and Fire Department Membership.
Length of time at first listed EMS or Fire Department.
Name of EMS and Fire Department Membership.
Length of time at second listed EMS or Fire Department.
Over the past 5 years, how manhy calls have you handled as an EMT?
How many years of EMT experience do you have?

Maximum file size: 5MB

Have your department run the "Crew Members EMS Incident Participation Report" in Image Trend (eMEDS) with an "incident date" for a 5-year period (or less as applicable.) Attach and upload your report here. (See Application Checklist for more report generation details.) Allowed file types: gif, jpg, jpeg, png, pdf.

Maximum file size: 5MB

Allowed file types: gif, jpg, jpeg, png, pdf.
Did you take EMT at Chesapeake College?

EMS Applicant Evaluations

Include the names of the company level supervisors who will be completing your EMS Applicant Evaluation Form.
First and last name, title, and department.
First and last name, title, and department.
Please explain why you want to be a paramedic in the space provided.

Signature and Date

I certify that the information on this application is true and accurate to the best of my knowledge. I am aware that falsification or misrepresentation may result in being denied admission, or if enrolled, dismissed from this program. I understand that final acceptance into the Emergency Medical Services Program shall be contingent upon satisfactory completion of a criminal background check and satisfactory completion of a health examination record. Fieldwork, clinical placements, and certification licensure will involve drug testing and background checks performed at the student's expense. Typing out your name and the date is your signature to this petition for admission to the Emergency Medical Services program.

First and last name and date, (MM/DD/YYYY)
Save Draft