Know How Inc e-App

On-line Application

After completing this application and submitting it, you will be taken to Paypal to make your class deposit or payment. Paramedic 2011 must use the paper application

NAME:	SOCIAL SECURITY NUMBER
ADDRESS:	EMAIL:
CITY: STATE: ZIP:	DATE of BIRTH: TELEPHONE:
EMPLOYER:	Employer's address: City:
If you are currently involved with EMS, please provide:	JOB DUTIES:
EMS/FIRE SERVICE NAME:	HOW LONG HAVE YOU BEEN INVOLVED IN EMS?
CITY: STATE:	FULL/PART TIME? PAID?
Program I am applying for:	Have you ever been charged with crimes other than traffic offenses?
Please describe any previous medical training:	*If YES, provide details:*
The EMT Program tuition is $470. The deposit due on application is $100, leaving a balance due of $370. See Course terms and conditions for details on our payment plans. (Skip this for CPR & Refresher & Critical Care Endorsement) Payment plan:	How did you hear of Know How?
Additional fees are charged by NREMT and KBEMS for certification and registration. Classes are filled on a first come, first serve basis with students meeting the Kentucky EMS Board Guidelines. EMT-Basic class size is limited to 28 students. The program may be extended due to unforeseen circumstances beyond instructor’s control. I have read and understood the attached Know How Inc. Privacy Disclosure. *No refund of tuition can be made.* For EMT-Basics, you must bring a copy of your GED or High School Diploma and a copy of your Drivers License to the first class. For Critical Care Paramedic, bring a copy of your Paramedic license and ACLS card.
By typing my full name, I certify that I have read the Course terms and conditions and agree to abide by them