AH EMS Program Application

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EMS Program Application

Galveston College EMS Program has a selective admissions process. This process is nondiscriminatory on the basis of race, color, national origin, gender, age, qualified disability, marital status, veteran's status, or sexual orientation in admissions to the program. Note: It is the student's responsibility to provide the program director written notification of any changes in contact information.

First Name:

Middle Name:

Last Name:

Student ID:

Cell Phone Number:

Email:

Date of Birth:

Student ID is required for program application.

Please visit "Apply Texas" to apply to Galveston College and return to the application once your ID has been acquired.

*Please note ID #s may take several business days*

Address:

City:

State:

Zip:

Program Information
Please indicate below which level of education you wish to achieve within the Galveston College EMS program. If you are currently registered as an EMT or Paramedic please indicate that below along with your state license number.

Please indicate which level of EMS certification you hold.

Number

Please select which EMS education and goal you wish to achieve?

If accepted into the program, will you apply for campus housing?

School Information

Please provide the names of schools you have attended and your cumulative GPA. Please send all official transcripts from all schools attended to the admissions office. These can be sent upon acceptance to Galveston College. Please type NA if you have not completed any college credit.

Institution:

Please list academic institutions you have attended.

GPA:

Please Calculate your cumulative GPA

Credit Hours Earned:

Conferred Degree:

I understand that falsifying any information on the application form may result in my application being denied and/or dismissal from the program. All accepted students will be required to pass a background check and drug screen and will need to submit documentation of required immunizations.

Yes, I understand

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