EMT Student Application
Fri 8-11AM Lab Session
Orientation Video
Are you automatically an EMT upon successful completion of our EMT course?
*
Yes
No
How many hours of class can you miss before you're disqualified from challenging the NREMT?
*
8
10
12
14
Do I need to have my webcam on to be considered present for the online lecture?
*
yes
no
Does retaking an exam change your score?
*
yes
no
What is required to start signing up for clinical rotations?
*
Hep B
MMR
TDAP
Varicella
TB test within 6 months of the first day of class
All of the above
You can move forward once your answers above are correct.
Form Calculator
Back
Next
Name
*
First Name
Last Name
Email
*
Confirmation Email
example@example.com
Birthdate [Must be 18 years old within two years of last day of class]
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cell Phone
*
Please enter a valid phone number.
Emergency Contact
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Motivations for becoming an EMT
*
Select all that apply to you
*
High School Student
UIC student
Loyola student
Northwestern student
IIT student
Depaul student
University of Chicago student
In transition period
Full time work
Military/Veteran
Other
Back
Next
My Products
*
prev
next
( X )
Spring 2026 Application Fee
Submission of an application and application fee will secure your spot in our next class
$
50.00
Payment Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Signature
*
Back
Next
Please review and submit your form.
Submit
Should be Empty: