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RN to EMT

1Student Information

2Course Options

3Agreement & Payment

Student Information
Full Name*
First Last
Email Address*
Please use your personal email address rather than a work or school account. Course instructions will be emailed to this address, and it will also become your username for logging into the online course.
Enter Email Confirm Email
Phone Number*
Just in case we can't reach you by email.
And your mailing address?
Please note the state of New York does not accept our courses.

Street Address Address Line 2 City State ZIP Code
Which state do you intend to apply for EMT certification?*
Note it is your responsibility to know the requirements for EMT certification in your state. Some states may have additional requirements beyond NREMT certification.

State
New York does not allow hybrid learning.*
Unfortunately, New York state does not accept EMT courses that contain a significant amount of online learning.
- I understand that this course will NOT be accepted by the state of New York, but I would like to take it anyway.
Ohio - additional EMT training requirement*
Ohio requires that EMT candidates receive training in dual lumen and extraglottic airway from an Ohio-approved training program before they can become certified in Ohio.
- I understand that I must complete this additional training with an Ohio-approved program.
Hawaii - additional EMT training requirement*
Hawaii requires EMT candidates to obtain NREMT certification plus additional training in advanced skills and at least 96 hours of supervised clinical experience with a Paramedic. You may still take our program to become eligible for NREMT certification as an EMT, but you will need to obtain the Hawaii-specific training and clinical experience elsewhere.
- I understand that I must complete this additional training and clinical experience through a Hawaii-approved program.

Agreement & Signature
Terms and Conditions*
- I understand and agree to the TERMS AND CONDITIONS
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Signature of Student
By typing my first and last name below, I verify understanding and agree to the terms and conditions. I also verify that the person completing this form is the student enrolling in the course.
First Last
Payment
Discount Code
Northwestern Health Verification*
- I verify that I am currently a student or faculty/staff member of Northwestern Health Sciences University.
Total
$0.00
Payment Method*
Credit Card*

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Invoice to a Sponsoring Organization
Did your organization give you a code to enter when registering?*
Organization ID Code*
Name of Organization*
Contact Person at Organization*
First Last
Phone of Contact Person*
Email of Contact Person*
Enter Email Confirm Email
Mailing Address of Organization*
Street Address Address Line 2 City State ZIP Code
Instruction for Submitting Invoice
Enter any specific instructions we should know about submitting an invoice to this organization (for example: what to include in the memo, etc).
Invoice Terms and Conditions*
- I understand and agree that the organization above has authorized payment for my course fees, and if payment is not received by the due date indicate in the invoice, my course registration will be canceled.

RN to EMT

Student Information

Course Options

Agreement & Signature

Payment

Invoice to a Sponsoring Organization