Enrollment (old) | RICTC EMS

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Program Application

Please complete the form to apply for a class position with us.

First Name

Date of Birth * required

Phone

Are You Currently Licensed

- Current State License

- State License Number

- State License Expiration

Currently Affliated?

Last Name

Email Address

Program Selection*

Do You Hold A NREMT Certification

- Current NREMT Level

- NREMT Number

- NREMT Expiration Date

Shirt Size*

- Agency Name

- Supervising Officer

- Agency Contact Number

Select a class *

EMR (Pricing varies please choose manual payment) - $1

EMT 07/13 - 10/24 ($1300 manual payment price) - $1339

Advanced EMT - Cardiac ($2,200 manual payment) - $2255

Refresher / Recertification (Pricing varies please choose manual payment) - $1

Continuing Education (Pricing varies please choose manual payment) - $1

Thanks for submitting!

© 2018 by Rhode Island Community Training Center

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