Paramedic Program Application 2026

Name*

First NameLast Name

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

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.I do NOT have a current EMT or AEMT License with the Utah Bureau of EMS. I understand that failure to have one prior to the start of the course will result in immediate dismissal.

Upload a copy of your current EMT/AEMT certification

Upload a copy of your current BLS CPR certification *

I am responsible to have a minimum of three (3) reference evaluations to be completed 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*

Upload any Unofficial Transcript(s) that contain recommended pre-requisite courses: Math 1010, English 1010, Human Anatomy, Human Physiology, Medical Terminology

Applicable Healthcare or Military Work Experience

Provide each employer's name, position held and years worked. 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)*

YesNo

If yes, upload documentation of agency sponsorship

I acknowledge that taking the Fisdap Entrance Exam is part of my application, the cost of which ($32) is my responsibility. (Further instructions will be provided after receipt of the application).

Agreement and Signature - By signing below, you signify your understanding of the significant commitment of time, resources and work to complete a Paramedic Program. With that understanding, you choose to pursue the Southwest Tech Paramedic Program with my best effort.*

STECH Paramedic Program Application