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Emergency Medical Services Lowry Campus - Center for Simulation 9235 E. 10th Drive, Rm. 143 Denver, Colorado 80230 Tel 303-340-7070 Fax 303-340-7209 Web www.ccaurora.edu/programs-classes/departments/ems
Thank you for your interest about our EMT program. EMT is a one semester, 12-credit certificate program located on our Lowry Campus. We offer two schedules every spring and fall (Mon-Wed-Fri 8:30 am – 5:30 pm or Tues-Thurs nights 6 – 10 pm and Saturdays 8:30 am – 5:30 pm) and one schedule (Mon-Wed-Fri nights 6 – 10 pm and Saturdays 8:30 am – 5:30 pm) in the shorter summer semester. You take all classes together following the schedule you choose. EMS 170 requires three 12-hour ride-a-longs (ambulance, fire, and/or hospital) that you will schedule outside of classroom hours through our Clinical Faculty who will have days/times you choose. Please pay particular attention to the attached EMT Essential Information form which lists additional things required by the program to remain eligible. Clinical rides cannot be scheduled until all the information is on file with our office. When applying to CCA, please declare the EMT Basic Certificate as secondary to your program of study to be awarded the certificate upon completion. If you are already a student at CCA in another program, you must add it. The EMT Basic Certificate alone does not have enough credits to be financial aid eligible. However, it is the prerequisite to the Paramedic Certificate, the A.A.S. in Paramedicine degree, and included in the A.A.S. in Fire Science Technology degree. Adding one of these as Primary to your degree plan will make EMT financial aid eligible. To make changes, go to https://CCAurora.formstack.com/forms/curriculum_20182019. Please note: You must use your CCA student assigned email address (not your personal email) when filling out the form or your request will be denied. Advising can help with this if you need it. Our program includes CPR certification and the National Registry of Emergency Medical Technicians (NREMT) Psychomotor Skills exam. Successful completion allows you to take the NREMT written exam to become nationally certified. NREMT certification is a requirement for obtaining EMT certification in Colorado. Being an EMT is your first step to becoming a Paramedic. Following is general information for the semester.
Emergency Medical Technician (EMT) Spring 2022 Schedules
01/21/2022 – 05/09/2022 M-W-F 8:30am – 5:30pm
EMS 121 4A0 EMS 122 4A0 EMS 123 4A0 EMS 124 4A0 EMS 170 4A0
EMT Fundamentals EMT Medical Emergencies EMT Trauma Emergencies EMT Special Considerations EMT – Basic Clinical
3 credits 4 credits 2 credits 2 credits 1 credit
CRN# 36803 CRN# 36805 CRN# 36807 CRN# 36809 CRN# 36811
01/18/2022 – 05/09/2022 Tues. & Thurs. 6:00 pm – 10:00 pm and Sat. 8:30 am – 5:30 pm
EMS 121 8A0 EMS 122 8A0 EMS 123 8A0 EMS 124 8A0 EMS 170 8A0
EMT Fundamentals EMT Medical Emergencies EMT Trauma Emergencies EMT Special Considerations EMT – Basic Clinical
3 credits 4 credits 2 credits 2 credits 1 credit
CRN# 36804 CRN# 36806 CRN# 36808 CRN# 36810 CRN# 36813
CPR Certification is included in the program. 12 credit hours total
Tuition = $2,463.67 + Books and Equipment (resident rates with COF applied - subject to change)
Prerequisites: All incoming EMT students are required to take the college Accuplacer assessment exam UNLESS you already have a degree or have successfully completed an accredited 100 level English course with a grade of “C” or better. Testing students must test into or above English/Reading CCR092. The test is available in the Testing Center on the CentreTech Campus or in Students must also be 18 and a U.S. Citizen, Permanent Resident, or lawfully present. Student Services in the West Quad on Lowry Campus. There is a proctoring fee for the exam.
Contact with Administrative Program Staff for the Information Packet is mandatory upon registration. All the Essential Information requested in our Information Packet is required to remain eligible in the program. This includes a Criminal Background Check and 10-Panel Drug Screen. Medical Marijuana IS NOT acceptable.
The Community College of Aurora EMS Program is accredited by the Commission on Accreditation of Allied Health Education Programs (www.caahep.org) upon the recommendation of the Committee on Accreditation of Educational Programs for the Emergency Medical Services Professions (CoAEMSP).
For more information, please contact: Cindy Smith Program Assistant - Public Service Lowry Campus, Center for Simulation 9235 East 10th Drive, Room 143, Denver, CO 80230 Phone: 303-340-7070 Fax: 303-340-7209 Cindy.Smith@CCAurora.edu Hours: Monday – Friday, 8:00am – 4:00pm When communicating, please provide your CCA student ID and program of study.
Ernie Navarette Pathways Advisor – Public Service Academic Advising Community College of Aurora Lowry Campus – West Quad L119 710 Alton Way, Denver, CO 80230 Phone: 303-340-7044 Ernie.Navarette@CCaurora.edu
EMS website: www.CCAurora.edu/programs-classes/departments/ems
Notice of Non-Discrimination
The Community College of Aurora prohibits all forms of discrimination and harassment including those that violate
federal and state law, or the State Board for Community Colleges and Occupational Education Board Policies 3-120
and 4-120. The College does not discriminate on the basis of sex/gender, race, color, age, creed, national or ethnic
origin, physical or mental disability, veteran status, pregnancy status, religion, genetic information, gender identity,
or sexual orientation in its employment practices or educational programs and activities. The Community College of
Aurora will take appropriate steps to ensure that the lack of English language skills will not be a barrier to admission
and participation in vocational education programs.
The College has designated Cindy Hesse, Director of Human Resources as the Affirmative Action (AA) Officer,
Equal Opportunity (EO) Officer and the Title IX Coordinator with the responsibility to coordinate the college’s civil
rights compliance activities and grievance procedures. If you have any questions, please contact her by e-mail at
Cindy.Hesse@CCAuorora.edu, by phone at 303-360-4752 or by US mail at 16000 East CentreTech Parkway,
Administration Building, Office # A207E, Aurora, Colorado 80011. Ms. Reyna Anaya, Dean of Student Services
serves as the Deputy Title IX Coordinator and may be reached by e-mail at Reyna.Anaya@CCAurora.edu, by phone
at 303-360-7421 or at 16000 East CentreTech Parkway, Administration Building, Office # A106F, Aurora, Colorado
80011.
You may also contact the Office for Civil Rights, U.S. Department of Education, Region VIII, Federal Office
Building, 1244 North Speer Boulevard, Suite 310, Denver, CO 80204, telephone (303) 844-3417
7/12/2021
EMT Books
Please bring your books the first day of class!
❖ Emergency Care and Transportation of the Sick and Injured, 12th Ed., AAOS bundled with
Student Workbook, 12th Ed.
eBook Audiobook
Assessments
Practice Activities
Test Prep
Flash Cards
Soft-Skill Simulations Bundled ISBN: 9781284236484 (Required)
❖ BLS for Healthcare Provider
American Heart Association Item #20-1102 ISBN: 9781616697686 (Required)
Please read this book before class starts.
CPR certification is within the first week of class.
Medical Equipment
Available at the Book Store in the Student Center on CentreTech Campus
303-360-4774 or via the college website at www.ccaurora.edu
Contact the Book Store for current prices.
❖ Stethoscope (Required)
❖ Blood Pressure Cuff (Recommended)
❖ EMS/EMS toolkit pouch (Recommended)
10/21/21
Revised 04/06/2021cs
COMMUNITY COLLEGE OF AURORA EMERGENCY MEDICAL TECHNICIAN (EMT) PROGRAM
ESSENTIAL INFORMATION REQUIRED FOR EMS 170 CLINICAL COURSE
The documentation listed below must be on file with the CCA EMS Office within the first three weeks of class. These are requirements of the contracted agencies used for EMS 170 Clinicals and for the EMS profession in general. Failure to comply by final deadline may result in failure of EMS 170 and completion of the program. Ensure your name appears on all documentation and provide your student ID when submitting. We strongly recommend you keep a clean copy of these in a file for yourself to provide future employers who will also ask for them when you get hired. Ways to submit:
• Email or Scan to Cindy.Smith@CCAurora.edu\
• Fax to 303-340-7209
• Leave in the Public Service Drop Box located outside of the Northeast door of the Center for Simulation on Lowry campus or outside of room 143 inside the building
• Mail to Community College of Aurora, EMS Program, 9235 E. 10th Drive, Denver, CO 80230 Use this checklist to keep track of your submissions. A confirmation email will be sent to your CCA student email when opened and officially received for your records. Patience is required due to the volume of email regularly received. 1. _____ College required Criminal Background Check and Drug Screen through CastleBranch – go to
http://cccs.castlebranch.com, choose EMS, Background Check and Drug Screen, pay $61.20. Please note: A Medical Marijuana Card does not make it acceptable and a Dilute Negative test result will require a re-test. There are additional release forms and information included in the packet (see #2 below).
2. _____ Completed CCA Background Check Release & Disclosure forms (4 forms are in the packet; two require Notary Service). A notary will be available during Orientation which is held first class.
If you plan to utilize the notary services, please have the completed, unsigned forms and a current driver’s license or picture ID ready as required to process.
3. _____ Verification of Hepatitis B series of 3 shots/dates. If you are just starting the series, the first shot must be received prior to scheduling clinicals and verification of the second due 30 days later.
4. _____ Verification of a negative TB test dated within the past 9 months of semester start or with a chest
x-ray and Physician statement that you are non-contagious if you test positive.
5. _____ Verification of two MMR (Measles, Mumps, Rubella) shots or titer immunity within the last 3 years
6. _____ Verification of two Varicella immunizations, of Chickenpox by a positive history, or titer immunity
7. _____ Verification of current TDap (Tetanus-Diphtheria-Pertussis) shot (check date, expires every 10 years)
8. _____ Verification of a Seasonal Flu Shot (Fall semester when it becomes available; copy for Spring) 9. _____ Clearance from a Physician (on letterhead, prescription pad, on the form included in packet, or a sports physical indicating you are in good health and able to participate in physical activities with no restrictions as listed in the Functional Job Description for all Emergency Technicians) 10. _____ Copy or picture of current Driver’s License or valid picture ID
11. _____ Completed Student Uniform Sheet (used for fitting and distribution). Uniforms are distributed
after census date.
EMS/FST Student Uniform Size Sheet
Student: ______________________ Student ID #: ___________
Program: EMT___ Paramedic___ FST ___ Term: __________20____
(Check the program you are taking this term) (Spring, Summer, or Fall)
Ladies Please Note: These are Men’s Sizes
Choose a size that will enable you to move and bend freely without restrictions.
All pants are to be worn at the waist with shirt tucked in – NO sagging
(Circle One Size for Each)
Polo Shirt Size S M L XL XXL XXXL
T-Shirt Size S M L XL XXL XXXL
Pant (BDU) Size XS/Reg S/Reg S/Long M/Reg M/Long L/Reg Waist/Length
Sizing Info Below L/Long XL/Reg XL/Long XXL/Reg XXL/Long
BDU Pant Size Information
Waist: XSmall – up to 27” Small – 27”- 31” Medium – 31”- 35” Large – 35”- 39”
XLarge – 39”- 43” XXLarge – 43”- 47” XXXLarge – 47” – 51”
Length: Regular – Inseam 29½” to 32½” Long – Inseam 32½” to 34½”
You will receive one of each item as part of your equipment fee. Additional items may be purchased in
the EMS/FST Administrative office. Cash, check (made payable to CCA EMS), or charge (Visa,
MasterCard, Discover, and HigherOne) is accepted for payment.
Cost of additional items without tax: T-Shirt: $17.00 Polo Shirt: $22.00 BDU: $30.00
Fire Academy Students Only FST Coordinator will set up an appointment before class starts to size you
Coat: _____/_____ Pants: _____/_____ Boots: ______ Fire Gloves: ________ Chest/Sleeve Waist/Length S, M, L, or XL
Hood: ____ Safety Glasses: ____ Leather Gloves: ____ Rope: ___ Helmet: ____
Gear Received: _________________________________ on __ / __ / 20__ Student Signature Revised 03/08/2021
PHYSICIAN’S STATEMENT OF MEDICAL EXAMINATION For the Community College of Aurora’s
EMT/Paramedic and Fire Academy Programs
Student’s Name: _______________________________________ Date of Birth: ____________ In order for this student to participate in the Community College of Aurora’s EMS and/or Fire Academy Programs, it is necessary that we have a complete record of health status. Please complete the following information and sign where indicated. I hereby certify that I have examined the above named student, have reviewed his/her medical history and make the following recommendations for his/her participation in the program’s didactic, psychomotor skill labs, clinicals, drill grounds, and internships: _____ CLEARED WITHOUT RESTRICTIONS _____ Cleared for LIMITED PARTICIPATION Reason for limited participation: ______________________________________________
________________________________________________________________________
________________________________________________________________________ _____ Follow-Up Needed: ________________________________________________________ Date to Return: _________________________ _____ NOT CLEARED FOR PARTICIPATON Reason for non-participation: ________________________________________________
________________________________________________________________________
________________________________________________________________________ Date of Physical: ________________________________ (Valid for 365 days unless rescinded) Signed By: _____________________________________ ______________________________ (Must be signed by a MD, PA, or NP) (Type/Print Name and Degree) Address: ______________________________________ City/State/Zip: _________________________________ Phone #: ______________________________________
Physician’s Stamp Must Appear Here
CastleBranch.com • phone: 888.723.4263
PortalsCommunity College of Aurora
Get Started
...Done! It's that easy.
Go to your portal URL and click: Select your school and specific program, then select the desired package.
This will bring you to our Acknowledgment Page, which provides information about your selected package. Users will confirm that they have viewed the information given and then be forwarded to their Order Review Page.
1: 2: 3:
PaymentDuring the online order process, you may be prompted to enter your Visa/Mastercard information or a payment authorization PIN provided by your school. cccs.castlebranch.com
Access myCBTo view your results or update requirements, you will access mycb.castlebranch.com with your username (email address) and password. If you need online assistance, access the Need Help? menu within your account.
Your Portal URL
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COMMUNITY COLLEGE OF AURORA CRIMINAL BACKGROUND CHECK INFORMATION
For EMT and Paramedic (Phase I) Programs
A recent change in the standards of the Joint Commission on Accreditation of Healthcare Organization (JCAHO) has resulted in a change to Community College of Aurora’s Educational Affiliation Agreements with clinical facilities throughout Colorado. The change requires that every student assigned to a clinical facility for the purpose of education and training must complete a criminal background check. Therefore, you will be required to complete a background check that will be evaluated for disqualifying factors. All background checks must be done through this CCA process even if you have previously had a background check completed by an employer or other agency. Logon to the Castlebranch website at http://cccs.castlebranch.com/. At this site you will find information on the process for obtaining and submitting your background check. Included with this information sheet, you will find documents, which include a list of disqualifying factors and release forms necessary for the college to process your background check. CCA will require that you submit originals of these release forms. Please note that two of the forms need to be notarized. A Notary is available in the EMS office. Your completed background check and drug screen will be pulled from the background check’s website by EMS Staff. The completed notarized CCA release forms are due at the EMS Office prior to the start of any EMT or Paramedic (Phase I) program. You may deliver the required information to EMS Program Administrative Staff in person or you may mail the required information to EMS Program Administrative Staff, 9235 E. 10th Drive, Room 117, Denver, CO 80230. You will not be able to progress to a clinical placement or internship without completed release forms and a completed background check that has been evaluated by the EMS Staff, and is on file at the college. Should your background check reveal any disqualifying factors, you will not be permitted to enroll or progress in the EMS Program. If this is the case you will be notified by the EMS Program.
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Process for Background Checks – EMS Program
The following process must be completed for ALL EMT and Paramedic (Phase I) applicants:
1. Complete the attached Informed Consent documents and return to the Community College of Aurora, EMS Program, 9235 E. 10th Drive, Room 143, Denver, CO 80230. The forms MUST be filled out completely and pages 1 & 3 of the forms must be notarized. A notary is available in the EMS department. Original forms MUST be submitted to the address listed above.
2. Logon to the background check website at http://cccs.castlebranch.com . Select the EMT or
Paramedic program, then Background Check and Drug Screen. Students are responsible for payment of the fees, which are paid directly to the background check company.
3. The completed background check report and drug screen will be directly pulled from the
background check website by the EMS Program. 4. Failure to submit complete, unaltered documents will delay your clinical placement and affect
your ability to progress through the EMS Program. Questions regarding your background check should be directed to the Castlebranch Background Check Agency
888-723-4263.
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COLORADO COMMUNITY COLLEGE SYSTEM (CCCS) DISQUALIFYING OFFENSES – EMS, FST, and Healthcare Programs
The Colorado Community College System (“CCCS”) and the State Board for Community Colleges and Occupational Education authorize the EMS, FST, and Healthcare programs to conduct a background investigation of all student applicants. The clinical sites used in the EMS, FST, and Healthcare programs require background checks of all potential students. The purpose is to maintain a safe and productive educational and clinical environment. New students who refuse to comply with the background investigation will not be allowed to enter a CCCS EMS, FST, or Healthcare Program. An Applicant will be disqualified from a CCCS EMS, FST, or Healthcare program based on the following guidelines:
• Any violent felony convictions of homicide. (No time limit)
• Crimes of violence (assault, sexual offenses, arson, kidnapping, any crime against an at-risk adult or juvenile, etc.) as defined in section 18-1.3-406 C.R.S. in the 10 years immediately preceding the submittal of application.
• Any offense involving unlawful sexual behavior in the 10 years immediately preceding the submittal of application.
• Any crime, the underlying basis of which has been found by the court on the record to include an act of domestic violence, as defined in section 18-6-800.3 C.R.S. in the 7 years immediately preceding the submittal of application.
• Any crime of child abuse, as defined in section 18-6-401 C.R.S. in the 7 years immediately preceding the submittal of application.
• Any crime related to the sale, possession, distribution or transfer of narcotics or controlled substances in the 7 years immediately preceding the submittal of application.
• Any felony theft crimes in the 7 years immediately preceding the submittal of application.
• Any misdemeanor theft crimes in the 5 years immediately preceding the submittal of application.
• Any offense of sexual assault on a client by a psychotherapist, as defined in section 18-3-405.5 C.R.S. in the 7 years immediately preceding the submittal of application.
• Crimes of moral turpitude (prostitution, public lewdness/exposure, etc.) in the 7 years immediately preceding the submittal of application.
• Registered Sex Offenders. ( No time limit)
• Any offense in another state, the elements of which are substantially similar to the elements of any of the above offenses.
• More than one (1) D.U.I. in the 7 years immediately preceding the submittal of application.
If the investigation reveals information that could be relevant to the application, the designated ndividual responsible for background checks may request additional information from the applicant. The offense shall be reviewed on a case-by-case basis. Students who have successfully completed the terms of a deferred adjudication agreement will not be disqualified. If any applicant feels the criminal background check is inaccurate, they may appeal the decision and request a review with the specific community college with whom they applied. It is the applicant’s burden to produce substantial evidence that proves the crimes charged are incorrect.
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NREMT Criminal Conviction Policy
A. Background
The National Registry of Emergency Medical Technicians (NREMT) has adopted a Criminal Conviction
Policy to safeguard the public from individuals who, in practice as an EMS professional, might pose a
danger to the public.
EMS professionals, under the authority of their state licensure, have unsupervised, intimate, physical
and emotional contact with patients at a time of maximum physical and emotional vulnerability, as well
as unsupervised access to a patient’s personal property. These patients may be unable to defend or
protect themselves, voice objections to particular actions, or provide accurate accounts of events at a
later time. EMS professionals, therefore, are placed in a position of the highest public trust.
The public in need of out-of-hospital medical services relies on state licensure and national certification
to assure that those EMS professionals who respond to their calls for aid qualify for this extraordinary
trust. For these reasons, the NREMT has adopted the following Criminal Conviction Policy to ensure
that individuals, who have been convicted of certain crimes, are identified and appropriately evaluated
as to whether they would pose a risk to public safety as an EMS provider.
B. Policy
1. The NREMT may deny an applicant eligibility to sit for a certification examination, deny
certification, suspend or revoke an individual’s certification, or take other appropriate action with
respect to the applicant’s certification or recertification based on an applicant’s felony criminal
convictions and all other criminal convictions (whether felony or misdemeanor) relating to
crimes involving physical assault, use of a dangerous weapon, sexual abuse or assault, abuse of
children, the elderly or infirm and crimes against property, including robbery, burglary and
felony theft.
2. All applicants for certification or recertification must disclose any criminal conviction as
required on an application.
3. This policy applies to an applicant’s plea of nolo contendre, a guilty plea, or plea agreement, as
well as a conviction after trial.
4. Applicants are not required to disclose any criminal conviction that has been expunged from the
public record or a deferred adjudication that did not result in the entry of a conviction judgment.
5. Failure to disclose a covered criminal conviction or the withholding of any material information
regarding such conviction shall be an independent basis for denial of eligibility to sit for a
certification examination, revocation of a certification or denial of an application for
recertification.
6. NREMT shall post on its website an applicant’s disclosure of any criminal conviction requiring
disclosure under this policy and advise licensing authorities of the availability of this
information.
7. NREMT may deny an applicant eligibility to sit for the certification examination, or take other
appropriate action, if the applicable state licensing authority, in any state in which the applicant
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holds or seeks a license as an EMS professional, denies the applicant’s eligibility to obtain, or
suspends or revokes, a license, based on a criminal conviction.
8. Notwithstanding the absence of any adverse action taken by an applicable state licensing
authority on the basis of an applicant’s criminal conviction, NREMT may deny an applicant
eligibility to sit for a certification examination or recertification if, in the NREMT’s sole
discretion, based on the following considerations, the NREMT determines that certification may
jeopardize public health and safety:
a. The seriousness of the crime.
b. Whether the crime relates to performance of the duties of an EMS professional.
c. How much time has elapsed since the crime was committed.
d. Whether the crime involved violence to, or abuse of, another person.
e. Whether the crime involved a minor or a person of diminished capacity.
f. Whether the applicant's actions and conduct since the crime occurred are consistent with
the holding of a position of public trust.
g. Whether the applicant is a repeat offender.
h. Whether the applicant has complied with all court orders and probationary requirements
associated with the conviction.
Any applicant or registrant subject to an adverse decision by the NREMT under this Policy may
appeal that decision as outlined in the NREMT Certification Eligibility, Discipline and Appeals
Policy.
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Community College of Aurora General Release and Authorization
Must submit original to Community College of Aurora, EMS Program I, ___________________________________________________, for myself, my successors, agents and estate, hereby release the State of Colorado, The State Board for Community Colleges and Occupational Education (SBCCOE), The Community College of Aurora and all current and former employees, agents and attorneys of the State of Colorado from any and all claims, causes of action, liabilities, expenses and for damages which I may assert against any of them as a result of my undergoing an EMS / Health Career Programs enrollment suitability background and reference check by the College. Furthermore, I hereby authorize any former employers and/or agents of a former employer, to provide said information to any representative of the College upon request. Furthermore, I, ________________________________________, for myself, my successors, agents and estate, herby release any former employer and/or any agents of a former employer from any and all claims, causes of action, liabilities, expenses and for damages which I may assert against any of them as a result of the information they provide to the College as part of the College’s criminal records and/or reference checking on me. Furthermore, I hereby authorize any representative of the College to provide a copy of my criminal record and or drug test results to any of the program’s clinical sites’ authorized representative, for the express purposes of securing my assignment to said clinical site or sites which is required by the Health Career (EMS Program) Program’s curriculum criteria and academic standards, upon request. Furthermore, I understand that this release shall be forever binding and no rescission, modification, or release there from may be made without the express written consent of Community College of Aurora EMS Program and SBCCOE. A photocopy of this release will be sufficient to authorize the release of the aforementioned information. BY: __________________________________________________________ Date: __________________ Signature must be notarized
Print Name: _______________________________________ Social Security No.: ________________________ __________________________________________________________________________________________ On________________________________, 20_____, before me, _____________________________________, Date Year Notary Public
Notary Public for county of _____________________________, state of _______________________________ personally appeared ______________________________________, who has satisfactorily identified him/herself Signer
as the signer to the above referenced document. Notary Seal
-1-
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Community College of Aurora Release Authorization
Must submit original to Community College of Aurora, EMS Program 1. In connection with your enrollment in the CCA EMS Program, the College may procure a criminal record
report on you as part of the process of considering your suitability for enrollment in this program. In the event that this report is utilized in whole or in part in making an adverse decision with regard to your enrollment in this program, before making the adverse decision, we will provide you with a copy of the criminal record we obtained as well as a written declaration of your rights under the law.
2. According to the Fair Credit Reporting Act, I am entitled to know if program enrollment is denied because
of information obtained by the College from a consumer reporting agency. If so, I will be notified and given the name and address of the agency or the source which provided the information.
3. I acknowledge that a telephonic facsimile (FA) or photographic copy shall be as valid as the original. 4. I hereby authorize, without reservation, any law enforcement agency, institution, information service
bureau, school, employer, reference or insurance company contacted by Community College of Aurora, or its agent, to furnish the information described in the background record check.
The following information is required by law enforcement agencies and other entities for positive identification purposes when checking public records. It is confidential and will not be used for any other purposes. I hereby release the employer, its agents and all persons, agencies, and entities providing information or reports about me from any and all liability arising out of the request for or release of any of the above mentioned information or reports. ________________________________________________________________________________________________________________ Please print your full name (Last, First, Middle) ________________________________________________________________________________________________________________ Please print other names you have used __________________________________________________________ ___________________________________________________ Home Address City, State, Zip Code __________________________________________________________ _____________________________________________ Social Security Number Date of Birth Sex: Female Male Race: Asian Black Hispanic White Other (Circle One) (Circle One) _________________________________________________ ______________________________________________ Driver’s License Number State Issuing License _________________________________________________ Name as it appears on license _________________________________________________ _______________________________ Signature Date
-2-
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Community College of Aurora
Disclosure to EMS Program Applicant Regarding the Procurement of a Consumer Report (Criminal Record)
Must submit original to Community College of Aurora, EMS Program In connection with your application for enrollment in the Community College of Aurora EMS Program, we may request/procure a criminal record on you as part of the process of considering your suitability for enrollment in this program. In the event that this report is utilized in whole or in part in making an adverse decision with regard to your potential enrollment in this program, before making the adverse decision, we will provide you with a copy of the criminal record we obtained as well as written declaration of your rights under the law. The Fair Credit Reporting Act gives you specific rights in dealing with consumer reporting agencies. You will find these rights summarized on a separate page of this document. By your signature below, you hereby authorize us to obtain a criminal record report on you in order to consider you for enrollment in the CCA EMS Program. Applicant’s Name: __________________________________________________ Please print Applicant’s Address: __________________________________________________ City/State/Zip: __________________________________________________ Signature: __________________________________________________ Signature must be notarized
On________________________________, 20_____, before me, _____________________________________, Date Year Notary Public
Notary Public for county of _______________________________, state of ______________________________ personally appeared ______________________________________, who has satisfactorily identified him/herself Signer
as the signer to the above referenced document.
Notary Seal
-3-
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Community College of Aurora EMS Program
Informed Consent
Must submit original to Community College of Aurora, EMS Program The EMS Program curriculum criteria and academic standards for course credit and program achievement require students enrolled in the EMS Program to undergo training at clinical sites. A critical element of determining a student’s suitability for participation in the program as well as assignment at one or more clinical sites during the course of his or her program is to determine that the student does not have a criminal record of drug-related and/or other felonies that might place the clinical site in jeopardy by the placement of an unsuitable student at their institution. The Community College of Aurora is required to declare to the hosting institution the suitability of every student assigned to that institution. Therefore, all EMS students must undergo a criminal record check as a term and condition of their enrollment in the College’s EMS Program. Any and all costs associated with the aforementioned criminal record check will be borne by EMS Program students. Further, all fees paid for criminal record checks are non-refundable. Prior criminal record checks results will not be accepted. The results of the aforementioned criminal records check will only be released by the relevant consumer reporting agency and healthcare provider to the Department Chair and Program Assistant of the EMS Program. This information will be maintained in a separate file from the student’s academic record. Access to this file will be governed by the Family Educational Rights and Privacy Act (FERPA).
General Release
I, ___________________________________, for myself, my successors, agents and estate, hereby release the State of Colorado, the State Board for Community Colleges and Occupational Education, Community College of Aurora, EMS Program, and all current and former employees, agents and attorneys of the State of Colorado from any and all claims, causes of action, liabilities, expenses and for damages which I may assert against any of them as a result of my undergoing a criminal records check as required for enrollment in the EMS Program. Furthermore, I understand that this release shall be forever binding and no rescission, modification, or release there from may be made without the express written consent of the Community College of Aurora and SBCCOE. Furthermore, I have received all the information necessary to make an informed decision regarding this release. I fully understand the terms and consequences of agreeing to this release, and acknowledge that I voluntarily and of my own free will am waiving my right to assert any action against the State of Colorado, the State Board for Community Colleges and Occupational Education, Community College of Aurora, EMS Program, and all current and former employees, agents and attorneys of the State of Colorado, and agents of Community College of Aurora performing services on behalf of the College, for any and all claims, causes of action, liabilities, expenses and for damages which I may assert against any of them as a result of my undergoing a criminal records check as required for enrollment in the College’s EMS Program.
Limited Release of Criminal Record Results
I, ____________________________________________, hereby authorize any representative of the Community College of Aurora, EMS Department Chair, and agents to release any and all information and/or medical records pertaining to my criminal record results to any authorized clinical site representative it deems appropriate in order to determine my suitability to enroll in the College’s EMS Program and/or to be assigned to a clinical site selected by the Program. A photocopy of this release will be sufficient to authorize the release of the aforementioned information. BY: _____________________________________________________________ Date: ___________________________ Student Signature
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EMS Tuition and Fees - Fall 2020 Rates*
7/12/2021
COURSE CREDIT RESIDENT EQUIP. REGIS. PROGRAM STUDENT ACTIVITY PARKING GOVT. FEE TECH TOTAL COF TOTAL
NUMBER HOURS TUITION FEES FEE FEE BOND FEE FEE $1.31 $1.88 FEE COSTS STIPEND WITH
$247.35 per $14.60 $7.60 $2.52 $22.04 per credit per credit $28.42 BEFORE $94.00 COF
per credit semester semester per credit per credit per term up to 12 hrs up to 12 hrs semester COF per credit STIPEND
EMT Semester
EMS 121-170 12 $2,968.20 $400.00 $14.60 $91.20 $30.24 $22.04 $14.41 $22.56 $28.42 $3,591.67 ($1,128.00) $2,463.67
Medic Phase 1
EMS 225+ 16 $3,957.60 $400.00 $14.60 $121.60 $40.32 $22.04 $15.72 $22.56 $28.42 $4,622.86 ($1,504.00) $3,118.86
Medic Phase 2
EMS 227+ 15 $3,710.25 $500.00 $14.60 $114.00 $37.80 $22.04 $15.72 $22.56 $28.42 $4,465.39 ($1,410.00) $3,055.39
Medic Phase 3
237/280/281 14 $3,462.90 $300.00 $14.60 $106.40 $35.28 $22.04 $2.62 $3.76 $28.42 $3,976.02 ($1,316.00) $2,660.02
A-Shift Total $8,834.27
Medic Phase 2
EMS 227+ 17 $4,204.95 $500.00 $14.60 $129.20 $42.84 $22.04 $15.72 $22.56 $28.42 $4,980.33 ($1,598.00) $3,382.33
Medic Phase 3
EMS 280/281 12 $2,968.20 $300.00 $14.60 $91.20 $30.24 $22.04 N/A N/A $28.42 $3,454.70 ($1,128.00) $2,326.70
TR/S Total $8,827.89
PROGRAM CREDIT NON_RESIDENT EQUIP. REGIS. PROGRAM STUDENT ACTIVITY PARKING GOVT. FEE TECH TOTAL
HOURS TUITION FEES FEE FEE BOND FEE FEE $1.31 $1.88 FEE COSTS
$629.25 $14.60 $7.60 $2.52 $22.04 per credit per credit $28.42
per credit per credit per credit per term up to 12 hrs up to 12 hrs
EMT Semester
EMS 121-170 12 $7,551.00 $400.00 $14.60 $91.20 $30.24 $22.04 $14.41 $20.68 $28.42 $8,172.59
Medic Phase 1
EMS 225+ 16 $10,068.00 $400.00 $14.60 $121.60 $40.32 $22.04 $15.72 $22.56 $28.42 $10,733.26
Medic Phase 2
EMS 227+ 15 $9,438.75 $500.00 $14.60 $114.00 $37.80 $22.04 $15.72 $22.56 $28.42 $10,193.89
Medic Phase 3
237/280/281 14 $8,809.50 $300.00 $14.60 $106.40 $35.28 $22.04 $2.62 $3.76 $28.42 $9,322.62
A-Shift Total $30,249.77
Medic Phase 2
EMS 227+ 17 $10,697.25 $500.00 $14.60 $129.20 $42.84 $22.04 $15.72 $22.56 $28.42 $11,472.63
Medic Phase 3
EMS 280/281 12 $7,551.00 $300.00 $14.60 $91.20 $30.24 $22.04 N/A N/A $28.42 $8,037.50
TR/S Total $30,243.39
EMT - All Schedules
A-Shift Cohort - Summer Semester
Both Paramedic Schedules - Phase 1
TR/S Clinical & Field Internships - Summer / Fall enrollment is based upon clinical completion and instructor approval
EMT - All Schedules
Resident Tuition
Non-Resident Tuition*
Fall (TR/S) and Spring (A-Shift) Paramedic Cohorts
A-Shift Clinical & Field Internships - Fall/Spring enrollment is based upon clinical completion and Instructor approval
TR/S Clinical & Field Internships - Summer / Fall enrollment is based upon clinical completion and instructor approval
TR/S Cohort - Spring Semester
* Subject to change
A-Shift Cohort - Summer Semester
TR/S Cohort - Spring Semester
A-Shift Clinical & Field Internships - Fall/Spring enrollment is based upon clinical completion and Instructor approval
EMS Tuition and Fees - Fall 2020 Rates*
7/12/2021
Alaska Arizona California Hawaii Idaho Montana Nevada New MexicoNorth
DakotaOregon
South
DakotaUtah
Washington Wyoming
COURSE CREDIT WUE EQUIP. REGIS. PROGRAM STUDENT ACTIVITY PARKING GOVT. FEE TECH TOTAL
NUMBER HOURS TUITION FEES FEE FEE BOND FEE FEE $1.31 $1.88 FEE COSTS
$230.05 $14.60 $7.60 $2.52 $22.04 per credit per credit $28.42
per credit per credit per credit per term up to 12 hrs up to 12 hrs
EMS 121 EMT
12 $2,760.60 $400.00 $14.60 $91.20 $30.24 $22.04 $14.41 $20.68 $28.42 $3,382.19
EMS 225 Paramedic PH1
16 $3,680.80 $400.00 $14.60 $121.60 $40.32 $22.04 $15.72 $22.56 $28.42 $4,346.06
EMS 227 Paramedic PH2
15 $3,450.75 $500.00 $14.60 $114.00 $37.80 $22.04 $15.72 $22.56 $28.42 $4,205.89
EMS 280 Paramedic PH3
14 $3,220.70 $300.00 $14.60 $106.40 $35.28 $22.04 $2.62 $3.76 $28.42 $3,733.82
C-Shift Total $12,285.77
EMS 227 Paramedic PH2
17 $3,910.85 $500.00 $14.60 $129.20 $42.84 $22.04 $15.72 $22.56 $28.42 $4,686.23
EMS 280 Paramedic PH3
12 $2,760.60 $300.00 $14.60 $91.20 $30.24 $22.04 N/A N/A $28.42 $3,247.10
TR/S Total $12,279.39
*Subject to change
Spring Semester Start (C-Shift Schedule) Phase 2 & Phase 3
Application is in MyCCA: https://ccaurora.formstack.com/forms/wue
The following states participate in WUE:
Common Wealth of Northern Islands
Fall Semester Start (TR/S Schedule) Phase 2 & Phase 3
Western Undergraduate Exchange (WUE)
Both Paramedic Schedules - Phase 1
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