EMT NREMT Exam Registration Form

Name *

First

Last

PSID Number (if Indiana Resident) *

If you are not an Indiana Resident, please put N/A in this field.

Address *

Address Line 1

City

State

Zip Code

County *

County

Cell *

Email *

Date of Birth *//

Age *

EMT NREMT Psychomotor Exam dates *

Dates to be confirmed

Must have a Course ID or State Authorization letter to test *

Please enter Course ID *

Exam Info *

Please choose the option that fits your needs, If retesting, please check which stations you need to retest. *

Additional information, Questions or Concerns

Emergency Contact *

First

Last

Emergency Contact

Emergency Contact Phone Number *

Relationship to student *

Where did you hear about us?

If Other, Please tell us more.

EMT NREMT Exam Registration