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Emergency Medical Sciences Application

Saturday, June 15, 2024

This application is for students who have completed an application to UA - Pulaski Tech. If you have any questions about this form or about the Emergency Medical Science (EMS) programs, please contact [email protected].

If no, leave blank.

If no, leave blank.

If no, leave blank.

If no, leave blank.

Have you ever had a professional license on probation, suspended or revoked in healthcare or any other field?
If seeking the EMT license are you interested in the day or night course?
If you are a current Arkansas licensed EMT, are you seeking: