SB8 EMSE Initiative

Your First and Last Name*

Hi, let's get started! Please enter your name (First Last)

Your email address*

PHONE*

Please enter your phone number. If you enter your cell phone number here, we will be able to communicate with you via text message regarding your funding status. Although your cellphone is not required, it is preferred.

Phone

Phone Type*

Yes, this is my cellphone.

No, this is not a cellphone.

ADDRESS*

What is your street address?

City*

What is the name of the city you live in?

County of Residence in Texas*

Please select your county of residence inTexas.

Select

RAC*

Please select your county RAC. If you are unsure, please select "I am unsure of my county RAC" at the end of the dropdown list.

I am unsure of my county RAC

Have you submitted your funding application to your RAC?*

Yes

No, this is the first step I have taken with applications for special funding.

Program Type*

Please select the School of EMS education program type you are enrolling into:

EMT

AEMT

Paramedic

Do you have an employer sponsor?*

Are you currently employed by a Texas EMS Provider / EMS Agency that will sponsor you for this special funding?

YES

SPONSOR*

Please enter your employer (potential sponsor) agency name:

Employer Sponsor Email

Please enter the email address of the contact at your employer for SOE to contact regarding your submission:

County in Texas of Interest*

If the school of EMS is able to match you with a potential employer to act as your sponsor for special funding, which Texas counties are you willing to work in?

Select

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