EMT Academy Interest Form

EMT Academy Interest Form

Please complete this form and submit it to the EMS Program. If you need to fax a document, please use 336-249-9053 or Mail to Diane Hedgecock (PSS 112) Davidson-Davie Community College PO Box 1287, Lexington, NC 27293. If you need to reach her by email please use Diane_Hedgecock@DavidsonCCC.edu or phone 336-224-4791
EMT STUDENT PREREQUISITES
1. 17 years of age on or before the official end date of the course

2. Possession of a high school diploma, high school equivalency or successful completion of an exam assessing basic reading comprehension skills at a minimum at the eleventh-grade level.
Today's Date

Month Day Year
Date
Name

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email
example@example.com
Phone Number

Area Code Phone Number
Are you a current or previous student at DDCC?

Yes No
Which program are you more so interested in?

Summer 2021 EMT Hybrid (Saturdays & Sundays 9a-6p, Online learning)
Required Materials for Submission:

If you need to complete the TABE or CASAS test for placement in English, Diane Hedgecock will give you that information at the time she contacts you to discuss your Interest Form.
Please submit the following documents to show eligiblity into the program, please submit all documents at the same time if possible.

Drivers License

High School Diploma (or equivalent)

**OR**

College Credit for English (transcript grade of C or higher)

**OR**

TABE/CASAS Test Reading Score of Level 11.0
Upload your proof of eligibility here:

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EMT Academy Interest Form

Required Materials for Submission: