EMT Instructor Course
Select desired class dates:
DOT MOI ($250)
July 6-8, 13-15, 2012
Alaska Specific ($175)
July 20-22, 2012
Basic Instructor ($150)
July 22, 27-29, 2012
Advanced Instructor ($125)
July 22, 27-28, 2012
Class times:
Fridays 6-10pm
Saturdays & Sundays 9am-6pm
Class location:
Mat-Su College
Palmer, Alaska
** Must attend all
hours of class. **
$100 discount* for all current or
previous UAA Paramedic
Program Students and Alumni.
(*pending approval)
The Mat-Su College Emergency Medical Technician Instructor
Course is offered in a modular fashion with the Methods of Instruction
(MOI), Alaska Specific, Basic Instructor, and Advanced Instructor
Orientations offered on Friday evening and Saturday and Sunday all
day.
The DOT MOI (Methods of Instruction) portion (or equivalent course if
approved by IPEMS) must be completed to become any level of EMT
instructor, but only must be taken once and need not be repeated if you
are a State Fire Instructor or if you have a previous Alaska EMT
Instructor certification.
Alaska Specific must be taken within the same 12 month period as the
Basic or Advanced Instructor to get your EMT-1, -2, or -3 instructor
certification.
Basic Instructor is required for anyone pursuing their EMT-1
Instructor certification. Applicants are required to be currently certified
as an Alaska EMT or paramedic, have passed a State of Alaska EMT-1
written exam for certification with a 90% or better AND passed a formal
EMT practical exam (EMT-1, -2, -3, or NREMT-Paramedic) for
certification within the 12 months prior to entry into the Basic Instructor
Orientation Class. They also must have 3 years’ experience as an EMT
or be licensed as an Alaska MICP.
Advanced Instructor is required for anyone pursuing their EMT-2/3
Instructor certification. Applicants are required to be currently certified
as an Alaska paramedic, physician, PA, or RN, and have passed a
State of Alaska EMT-3 written exam for certification with a 90% or better
AND passed a formal EMT-3 or NREMT-Paramedic practical exam for
certification within the 12 months prior to entry into the Basic Instructor
Orientation Class. They also must have 3 years’ experience as a
Paramedic or be licensed as an Alaska MICP. Physicians, PAs, or RNs
must have 3 years’ experience as an EMT or paramedic. All EMT-2/3
candidates must provide evidence of current ACLS provider or instructor
status.
EMT-1 or 2/3 instructor candidates must also show proof or CPR
Instructor Certification or sign a waiver indicating that someone else
will be teaching CPR for your students.
Please note the registration deadline for the course (June 27).
Payment in full is required at the time of initial registration to reserve a
place in the class. MSC reserves the right to cancel this class if
enrollment is less than 6 students on June 29. If class is cancelled by
MSC your tuition will be fully refunded. There will be no refunds for
cancellations on or after June 29.
Complete application
due by:
June 27, 2012
EMT Instructor Course
Candidate Application
NAME:
ADDRESS:
CITY:
STATE:
ZIP:
PHONE: Home:
Work:
Fax:
E-MAIL ADDRESS:
LEVEL OF CURRENT CERTIFICATION: (Check all that apply)
EMT-I
EMT-II
EMT-III
MICP
NREMT-B
NREMT-I
NREMT-P
RN
DO
MD
PA
EMS AFFILIATION:
_______________________________________________________________________________
(Name of Service)
NUMBER OF YEARS IN EMS:
_______________________________________________________________________
ARE YOU CURRENTLY A CPR INSTRUCTOR?
YES NO
If yes, what organization: ____________________________________________________________
If yes, exp. date:
Location:
TC Affiliation:
If no, will you be planning on attending a CPR Instructor Course? YES NO
Questions may be directed to Kathy Griffin at cell: (907) 982-5996
Tuition is due upon final acceptance into the course.
Complete application
due by:
June 27, 2012
EMT Instructor Course
Prerequisites: (attach documentation)
Copy of Current License or Certificate as an EMT, MICP, RN, PA, NP, DO or MD
Copy of CPR instructor certificate or signed waiver
Documentation of three (3) years experience as an EMT and/or paramedic (may include non-Alaska
experience). This is not required if MICP. See page 1 for more details.
Practical exam at EMT- ___ level complete:
Location: _______________ Date: __________
Written Exam at EMT- _____ level completed and score received with 90% or greater.
(Use Instructor Candidate Code when testing)
Copy of 40-hour MOI course certificate or letter from IPEMS approving exemption (if exempting from
first week)
Cover letter documenting EMS and teaching experience
Copy of ACLS card (EMT-III Instructors only)
**Your application is not considered complete until all of these documents have been received.
Desired Courses:
DOT MOI
$250
Alaska Specific Orientation (All levels) * See box below
$175
Basic Instructor Orientation (EMT-I Instructor)
$150
Advanced Instructor Orientation (EMT-III Instructor) must be paramedic, RN,
PA or physician
$150
Current student or past alumni of the KPC or MSC Paramedic Program
(pending approval)
-$100
Total Due:
***Do not send payment at this time***
After your application has been reviewed and all documentation meets criteria, you will be invoiced by the
University of Alaska Mat-Su College and can pay via cash, credit card, or check through the MSC Campus
Cache. All payments will be required by June 29, 2012.
Please send all required documentation to:
Kathryn Griffin
Mat-Su College EMS Programs
P.O. Box 2889, Palmer, AK 99645
Cell: 907-982-5996
Fax: 907-746-9383
Complete application
due by:
June 27, 2012
