Paramedic Program Application 2025

STECH Paramedic Program Application
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
EMT or AEMT License*

I have a current EMT or AEMT license with the Utah Office of EMS. I will maintain a current license throughout the entirety of the Paramedic Program. Upon request I will provide proof of current CPR certification.
Upload a Copy of any Additional Certifications (Optional)

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References*

I am responsible to have 3 reference evaluations submitted prior to the application deadline.
Three reference evaluations are required.
Please submit up to five Names & Email Addresses.

First Name   Last Name   Email
First Name   Last Name   Email
First Name   Last Name   Email
First Name   Last Name   Email
First Name   Last Name   Email
Strongly recommended prerequisites are:

Math 1010English 1010Medical TerminologyHuman AnatomyHuman Physiology
Strongly recommeded prerequisites are:

Math 1010English 1010Medical TerminologyHuman AnatomyHuman Physiology
Upload any Unofficial Transcript(s) that contain recommended pre-requisite courses

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Applicable Healthcare Work Experience
Include the name of the agency, position and job description, and the start and end date that you worked there. List the most recent work experience first.
Explain the behaviors and attitudes that you believe are required to be a successful paramedic student and eventual professional paramedic. (150 words or less)*
Describe what being resilient means to you and the attributes that you possess that help you to accomplish personal resiliency. (150 words or less)*
Briefly describe your interest in becoming a paramedic and the plan or resources and support you anticipate using to complete the program. (150 words or less)*
Are you being sponsored by an agency/fire department?*

YesNo
If yes, by which agency/fire department?
FISDAP Entrance Exam*

I acknowledge that taking the Fisdap Entrance Exam is part of my application, the cost of which ($26) is my responsibility. (Further instructions will be provided after receipt of the application).
Agreement and Signature - By signing below, I signify my understanding of the significant commitment of time, resources and work to complete a Paramedic Program. With that understanding, I choose to pursue the Southwest Tech Paramedic Program with my best effort.*

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STECH Paramedic Program Application