Paramedic Program Initial Registration Form

** IMPORTANT **
Fill out this form to show your interest in our Paramedic Program. Once you submit it, someone from our team will reach out to you with the next steps to finish the registration process.

Depending on your email inbox settings, this important message might end up in your junk mail folder. If you haven’t heard back from us within 2 business days after sending your application, be sure to check your junk mail folder. If you still don’t see a response, feel free to reach out to us.

Every student joining the Paramedic Program needs to get a PSID number (Public Safety Identification) from the Indiana Department of Homeland Security. It’s important for students to have their PSID ready before classes start. Even students coming from outside Indiana must obtain a PSID before the class begins.
Apply for a PSID.

Payment Methods: We will send you an electronic invoice that you can easily access whenever you want.

Course cost: $13,500 (Excludes Housing and Car Rental)

This includes:

• Tuition
• Paramedic textbook
• Lab supplies
• Clinical shirts: 2 polos and T-shirt
• 2 photo ID badges
• National Registry Skills Exam
• National Registry Test Prep Course
• ACLS, PHTLS & PALS Certifications
• 1st National Registry Cognitive Exam 

This cost does NOT include:

• Housing
• Meals
• Transportation
• Classroom supplies
• Electronic devices
• Health insurance

Click HERE for details on Student Housing

Student Information

Name *

First

Last

Email *

Email

Confirm Email

PSID Number *

Date of Birth *

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Age *

Gender *

• Male
• Female

Cell *

Shirt Size *SmallMediumLargeXL2XL3XL

Are you interested in on-site housing? *

• Yes
• No

Emergency Contact Name *

First

Last

Emergency Contact Phone Number *

Relationship to student *

Address *

Address Line 1

City

— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

County *

County

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

— Select country —AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountry

For International Students

• International Address

GI Bill Benefits for Veterans *

• Yes
• No

Do you have a Letter of Eligibility? *

• Yes
• No

Social Security Number *

Paramedic Program Course dates *

• October 12th, 2026 – February 4th, 2027
• January 4th, 2027 – April 28th, 2027
• March 29th, 2027 – July 21st, 2027
• June 21st, 2027 – October 13th, 2027

Do you have any learning disabilities, allergies or medical information we need to be made aware of? *

• Yes
• No

Are you being sent by your employer? *

• Yes
• No

Please enter company name *

Will you be driving your own vehicle? *

• Yes
• No

If you are not, we can help arrange for a rental, or for you to carpool with another student, please contact us if you need any assistance

Please provide details *

Please be specific so instructors are aware for hands-on scenario situations

Additional information, Questions or Concerns

Where did you hear about us?

• Web Search
• Facebook
• X
• Instagram
• TikTok
• In-Person Event
• Referral from Friend/Colleague
• Other

If Other, Please tell us more.

Submit