2025-2026 College EMS Program and Course Notification Form

Demographic Information

School*

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Program Coordinator Name*

Phone Number*

Phone

Email Address*

Name of Medical Director*

Date of Application

Academic Year:*

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Attestation

Verification of Instructional Credentials and Requirements

I verify the course directors and instructors meet the qualifications and requirements outlined in Oregon Administrative Rule 333-264.*

Verification of Oregon EMS Provider Licenses

I verify all instructors in each course hold current and valid Oregon licenses.*

Verification of Minimum Course Requirements

I verify each course meets the minimum course requirements as described in Oregon Administrative Rules 333-264 and 333-265.*

Course Planner: Fall Term Offerings

Courses Starting in Fall Term

Note: for courses that last longer than one term, only enter them once on this form. For example, an EMT course that is scheduled for fall and winter terms should be entered into the Fall Term Offerings section only.

Fall Term: Number of EMT Courses Planned*

** If you are planning more than five courses, please select 5 as the maximum for this form and submit the other courses' information by email to leslie.d.huntington@oha.oregon.gov **

Select

Fall Term EMT Course 1: Course Director Name*

Type in the name as it is listed on their Oregon EMS provider license.

Fall Term EMT Course 1: Duration*

Select or enter value

Fall Term EMT Course 1: Site and Delivery*

Select or enter value

Fall Term EMT Course 2: Course Director Name*

Type in the name as it is listed on their Oregon EMS provider license.

Fall Term EMT 2: Course Duration*

Select or enter value

Fall Term EMT Course 2: Site and Delivery*

Select or enter value

Fall Term EMT Course 3: Course Director Name*

Type in the name as it is listed on their Oregon EMS provider license.

Fall Term EMT Course 3: Duration*

Select or enter value

Fall Term EMT Course 3: Site and Delivery*

Select or enter value

Fall Term EMT Course 4: Course Director Name*

Type in the name as it is listed on their Oregon EMS provider license.

Fall Term EMT Course 4: Duration*

Select or enter value

Fall Term EMT Course 4: Site and Delivery*

Select or enter value

Fall Term EMT Course 5: Course Director Name*

Type in the name as it is listed on their Oregon EMS provider license.

Fall Term EMT Course 5: Duration*

Select or enter value

Fall Term EMT Course 5: Site and Delivery*

Select or enter value

Fall Term: Number of AEMT Courses Planned*

Fall term: AEMT Courses

** If you are planning more than one course, please select 1 as the maximum for this form and submit the other courses' information by email to leslie.d.huntington@oha.oregon.gov **

Select

Fall Term AEMT Course 1: Course Director Name*

Type in the name as it is listed on their Oregon EMS provider license.

Fall Term AEMT Course 1: Duration*

Select or enter value

Fall Term AEMT Course 1: Site and Delivery*

Select or enter value

Is the EMT-I course embedded in the AEMT course?*

Select or enter value

Fall Term: Number of EMT-I Courses Planned*

For EMT-I courses that will be taught as a stand-alone offering (separate from an AEMT course).

** If you are planning more than one course, please select 1 as the maximum for this form and submit the other courses' information by email to leslie.d.huntington@oha.oregon.gov **

Select

Fall Term EMT-I Course: Course Director Name*

Type in the name as it is listed on their Oregon EMS provider license.

Fall Term EMT-I Course: Site and Delivery*

Select or enter value

Course Planner: Winter Term Offerings

Courses Starting in Winter Term

Note: for courses that last longer than one term, only enter them once on this form. For example, an EMT course that is scheduled for winter and spring terms should be entered into the Winter Term Offerings section only.

Winter Term: Number of EMT Courses Planned*

** If you are planning more than five courses, please select 5 as the maximum for this form and submit the other courses' information by email to leslie.d.huntington@oha.oregon.gov **

Select

Winter Term EMT Course 1: Course Director Name*

Type in the name as it is listed on their Oregon EMS provider license.

Winter Term EMT Course 1: Duration*

Select or enter value

Winter Term EMT Course 1: Site and Delivery*

Select or enter value

Winter Term EMT Course 2: Course Director Name*

Type in the name as it is listed on their Oregon EMS provider license.

Winter Term EMT Course 2: Duration*

Select or enter value

Winter Term EMT Course 2: Site and Delivery*

Select or enter value

Winter Term EMT Course 3: Course Director Name*

Type in the name as it is listed on their Oregon EMS provider license.

Winter Term EMT Course 3: Duration*

Select or enter value

Winter Term EMT Course 3: Site and Delivery*

Select or enter value

Winter EMT Course 4: Course Director Name*

Type in the name as it is listed on their Oregon EMS provider license.

Winter Term EMT Course 4: Duration*

Select or enter value

Winter Term EMT Course 4: Site and Delivery*

Select or enter value

Winter Term EMT Course 5: Course Director Name*

Type in the name as it is listed on their Oregon EMS provider license.

Winter Term EMT Course 5: Duration*

Select or enter value

Winter Term EMT Course 5: Site and Delivery*

Select or enter value

Winter Term: Number of AEMT Courses Planned*

Winter Term: AEMT Courses

** If you are planning more than one course, please select 1 as the maximum for this form and submit the other courses' information by email to leslie.d.huntington@oha.oregon.gov **

Select

Winter Term AEMT Course 1: Course Director Name*

Type in the name as it is listed on their Oregon EMS provider license.

Winter Term AEMT Course 1: Duration*

Select or enter value

Winter Term AEMT Course 1: Site and Delivery*

Select or enter value

Is an EMT-I course embedded in the AEMT course?*

Select or enter value

Winter Term: Number of EMT-I Courses Planned*

For EMT-I courses that will be taught as a stand-alone offering (separate from an AEMT course).

** If you are planning more than one course, please select 1 as the maximum for this form and submit the other courses' information by email to leslie.d.huntington@oha.oregon.gov **

Select

Winter Term EMT-I Course: Course Director Name*

Type in the name as it is listed on their Oregon EMS provider license.

Winter Term EMT-I Course: Site and Delivery*

Select or enter value

Course Planner: Spring Term Offerings

Courses Starting in Spring Term

Note: for courses that last longer than one term, only enter them once on this form. For example, an EMT course that is scheduled for spring and summer terms should be entered into the Spring Term Offerings section only.

Spring Term: Number of EMT Courses Planned*

** If you are planning more than four courses, please select 4 as the maximum for this form and submit the other courses' information by email to leslie.d.huntington@oha.oregon.gov **

Select

Spring Term EMT Course 1: Course Director Name*

Type in the name as it is listed on their Oregon EMS provider license.

Spring Term EMT Course 1: Duration*

Select or enter value

Spring Term EMT Course 1: Site and Delivery*

Select or enter value

Spring Term EMT Course 2: Course Director Name*

Type in the name as it is listed on their Oregon EMS provider license.

Spring Term EMT Course 2: Duration*

Select or enter value

Spring Term EMT Course 2: Site and Delivery*

Select or enter value

Spring Term EMT Course 3: Course Director Name*

Type in the name as it is listed on their Oregon EMS provider license.

Spring Term EMT Course 3: Duration*

Select or enter value

Spring Term EMT Course 3: Site and Delivery*

Select or enter value

Spring Term EMT Course 4: Course Director Name*

Type in the name as it is listed on their Oregon EMS provider license.

Spring Term EMT Course 4: Duration*

Select or enter value

Spring Term EMT Course 4: Site and Delivery*

Select or enter value

Spring Term: Number of AEMT Courses Planned*

Spring term: AEMT Courses

** If you are planning more than one course, please select 1 as the maximum for this form and submit the other courses' information by email to leslie.d.huntington@oha.oregon.gov **

Select

Spring Term AEMT Course 1: Course Director Name*

Type in the name as it is listed on their Oregon EMS provider license.

Spring Term AEMT Course 1: Duration*

Select or enter value

Spring Term AEMT Course 1: Site and Delivery*

Select or enter value

Is the EMT-I course embedded in AEMT?*

Select or enter value

Spring Term: Number of EMT-I Courses Planned*

For EMT-I courses that will be taught as a stand-alone offering (separate from an AEMT course).

** If you are planning more than one course, please select 1 as the maximum for this form and submit the other courses' information by email to leslie.d.huntington@oha.oregon.gov **

Select

Spring Term EMT-I Course: Course Director Name*

Type in the name as it is listed on their Oregon EMS provider license.

Spring Term EMT-I Course: Site and Delivery*

Select or enter value

Course Planner: Summer Term Offerings

Courses Starting in Summer Term

Summer Term: Number of EMT Courses Planned*

** If you are planning more than three courses, please select 3 as the maximum for this form and submit the other courses' information by email to leslie.d.huntington@oha.oregon.gov **

Select

Summer Term EMT Course 1: Course Director Name*

Type in the name as it is listed on their Oregon EMS provider license.

Summer Term EMT Course 1: Duration*

Select or enter value

Summer Term EMT Course 1: Site and Delivery*

Select or enter value

Summer Term EMT Course 2: Course Director Name*

Type in the name as it is listed on their Oregon EMS provider license.

Summer Term EMT Course 2: Duration*

Select or enter value

Summer Term EMT Course 2: Site and Delivery*

Select or enter value

Summer Term: Number of AEMT Courses Planned*

Summer Term: AEMT Courses

** If you are planning more than one course, please select 1 as the maximum for this form and submit the other courses' information by email to leslie.d.huntington@oha.oregon.gov **

Select

Summer Term AEMT Course 1: Course Director Name*

Type in the name as it is listed on their Oregon EMS provider license.

Summer Term AEMT Course 1: Duration*

Select or enter value

Summer Term AEMT Course 1: Site and Delivery*

Select or enter value

Is EMT-I embedded in the AEMT course?*

Select or enter value

Summer Term: Number of EMT-I Courses Planned*

For EMT-I courses that will be taught as a stand-alone offering (separate from an AEMT course).

** If you are planning more than one course, please select 1 as the maximum for this form and submit the other courses' information by email to leslie.d.huntington@oha.oregon.gov **

Select

Summer Term EMT-I Course: Course Director Name*

Type in the name as it is listed on their Oregon EMS provider license.

Summer Term EMT-I Course: Site and Delivery*

Select or enter value

Course Planner: Paramedic Courses

Course Planner: Paramedic Courses

Does your program offer paramedic courses?*

Select or enter value

Current Accreditation Status - CoAEMSP*

List the program's current status from CoAEMSP.

How many paramedic courses will be offered?*

Number of offerings for the academic year.

** If you are planning more than three courses, please select 3 as the maximum for this form and submit the other courses' information by email to leslie.d.huntington@oha.oregon.gov **

Select

Paramedic Course 1: Course Director Name*

Type in the name as it is listed on their Oregon EMS provider license.

Paramedic Course 1: Starting Term*

Select or enter value

Paramedic Course 1: Ending Term*

Select the term when all course components, including clinical and field internships, are scheduled to finish.

Select or enter value

Will Course 1 be offered at a satellite location?*

A satellite location is considered one that hosts physical classroom instruction for a majority of the course but is not located on a college-owned site or campus.

Select or enter value

List the name and location of each satellite site.*

List the name of the agency or college.

Paramedic Course 2: Course Director Name*

Type in the name as it is listed on their Oregon EMS provider license.

Paramedic Course 2: Starting Term*

Select or enter value

Paramedic Course 2: Ending Term*

Select the term when all course components, including clinical and field internships, are scheduled to finish.

Select or enter value

Will Course 2 be offered at a satellite location?*

A satellite location is considered one that hosts physical classroom instruction for a majority of the course but is not located on a college-owned site or campus.

Select or enter value

Name the location of the satellite site(s)*

Paramedic Course 3: Course Director Name*

Type in the name as it is listed on their Oregon EMS provider license.

Paramedic Course 3: Starting Term*

Select or enter value

Paramedic Course 3: Ending Term*

Select the term when all course components, including clinical and field internships, are scheduled to finish.

Select or enter value

Will Course 3 be offered at a satellite location?*

A satellite location is considered one that hosts physical classroom instruction for a majority of the course but is not located on a college-owned site or campus.

Select or enter value

Name the location of each satellite site.*

End of form. Click the 'Submit' button below to send the form to the OHA-EMS education program.

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