Wilson County Emergency Services District No. 3

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Class Registration

Name: Last, First, Middle

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City, State, Zip

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Email:

Course Applying For:

Date of Birth

SS# (for criminal background check) (for EMT & AEMT students only)

ID/DL #

Issuing State:

Expriation Date:

Have you been convicted of a Felony, Class A, or Class B Misdemeanor

Explain the charge or type N/A

Do you have a high school diploma or GED?

Name of High School/College graduated from

Submit a minimum of 300 words explaining why you want to be an EMT or AEMT

FOR ONLINE CLASSES ONLY: By clicking yes, you acknowledge the on-line course you have signed up for is self taught, and self paced. You have 4 months total to complete the course. This also includes 2 weeks at the end of the course which you will have to commit time to complete skills, and clinical hours.

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How did you hear about us?

Wilson County Emergency Services District No. 3

Mailing Address

P.O. Box 656

Stockdale, TX, 78160

Physical Address

Business Offices

656 W. Wheeler St

Stockdale, TX 78160

911

830-996-3087

830-996-1607

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