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DARTON COLLEGE OF HEALTH PROFESSIONSAPPLICATION PACKET
EMERGENCY MEDICAL SERVICESDARTON COLLEGE OF HEALTH PROFESSIONSAPPLICATION PROCEDURESI.APPLY TO ALBANY STATE UNIVERSITYA. Submit an “Application for Admission” to Albany State University’s Office of Admissions,which can be found via their “How to Apply” webpage.List 0589 (AEMT) or 0566 (EMT-P) as the code for“proposed college major”If you are a returning student from the former Darton State, please complete the Application forReadmission into the University and contact the Undergraduate Admissions Office viaEnrollment Management Services (229-500-4358) and have them reactivate your student file.B. Request that your high school send your official transcript to ASU or submit GED EquivalencyCertificate to Admissions Office.C. Request that official transcripts from any college or technical school that you have attended besent to ASU. If you have completed 30 or more semester hours of college transfer credit (notincluding Learning Support courses), it is not necessary to submit a high school transcript.D. Please review the Undergraduate Admissions Requirements provided by the Office ofAdmissions. To set up a placement exam go to the Testing Center’s “Placement Exam” webpage,which will also provide you with information regarding preparation.E. Though not required, students who take the Scholastic Aptitude Test (SAT) and score 430 orhigher on the verbal portion and 400 or higher on the math portion (or 17 or higher on the verbalportion of the American College Test (ACT) and 17 or higher on the math portion) may beadmitted without taking the Compass Exam.F. Complete the Darton College of Health Professions Immunization form. Take the ENCLOSEDIMMUNIZATION FORM to your local health department or personal physician forcompletion. You will need to turn in a COPY of the Immunization Form with yourAdmissions Application. Turn in the ORIGINAL Immunization Form with your EMSProgram Application.G. Go to U.S. Department of Education’s Office of Federal Student Aid website and complete theFree Application for Federal Student Aid (FAFSA ). Even if you do not think you will beeligible for PELL, completing this process is required so the financial aid office can determineyour HOPE eligibility. The FAFSA paperwork is also required for student loans.
EMERGENCY MEDICAL SERVICESDARTON COLLEGE OF HEALTH PROFESSIONSII.FINANCIAL AID APPLICATIONStudents may be eligible for the HOPE Grant as long as (1) the declared major is the EmergencyMedical Technician Certificate Program 0589 or 0566, (2) have not been convicted of a felony, (3) havenot used all HOPE dollars, or (4) have not defaulted on any student loans. After acceptance to ASU, thestudent should begin the process for financial aid (229-500-2020) as soon as possible. Please see theonline financial aid information via the Office of Financial Aid’s webpage. Students will need to applyfor the FAFSA to receive the HOPE Grant.III.STUDENT HEALTH INSURANCE **It is the policy of University System of Georgia (USG) that all students of Health Science Programs arerequired to have student health insurance that meets the minimum standards as set by the USG. Studentswho are not covered by a policy held by a parent, spouse, company or organization on the approvedwaiver list or if the policy does not meet the minimum standards must purchase the USG SHIP policy.Students who are already covered by an insurance policy can easily opt out of the plan through a secureon-line process. Once the information has been verified, all charges will be waived. Students who fail tosubmit creditable health insurance information will automatically be enrolled in and billed for thesystem-wide student health insurance plan. Check with the Business and Financial Services Department(229-500-2020) for the exact deadline dates for submitting a waiver. The waiver period at our institutionis strictly enforced.** This is done after the semester starts and must be repeated each semester.
EMERGENCY MEDICAL SERVICESDARTON COLLEGE OF HEALTH PROFESSIONSAPPLICATION CHECKLISTFor admission into the ASU Darton College of Health Professions EMS program, the following must becompleted prior to the beginning of the semester for which you intend to enroll:ASU Enrollment Processa. Admit/Re-admit applicationb. Entrance Exam (may be exempt)c. Copy of Darton College of Health Professions Immunization Formd. Federal Aid Applications (HOPE / PELL /FAFSA)e. Verification of Lawful Presence (see “How to Apply” webpage)In addition to meeting the requirements for general college admission, prospective EMS students must submitthe following information to their Emergency Medical Services Program advisor:ASU Darton College of Health Professions EMS Program Application ProcessPlease submit your EMS Program application as soon as possiblea. Complete the enclosed/attached EMS Program application.b. Copy of Driver’s licensec. Copy of your high school diploma or GED equivalency certificated. Unofficial Transcript(s)e. Original Darton College of Health Professions Immunization FormPlease mail completed EMS application materials to:Rhonda HuntEmergency Medical Services ProgramDarton College of Health ProfessionsASU-West Campus2400 Gillionville RdAlbany, GA 31707229-500-2241 / 478-256-5495rhonda.hunt@asurams.edu
EMERGENCY MEDICAL SERVICESDARTON COLLEGE OF HEALTH PROFESSIONSApplication: Emergency Medical Services ProgramPlease print neatly and accurately. Photocopying of the application is acceptable.ASU ID#: 900Course Interest: EMT/AEMT (This is the entry-level EMS program) Paramedic (Must currently be an AEMT or EMT-I)Demographic Information: Ms. Mrs. Mr.Name:Social Security #:Date of Birth:Address:City:Home Phone #:Cell Phone #:State:Zip:Preferred E-mail Address:Have you taken any of the following courses? Check all that apply. BIOL 1100K (Human Anatomy and Physiology for the Health Care Professional) BIOL 2411K (Human Anatomy and Physiology I) BIOL 2412K (Human Anatomy and Physiology II)Briefly list any medical and/or emergency services experience:UPON SUBMISSION, ALL APPLICATION PACKETS BECOME THE PROPERTYOF THE DARTON COLLEGE OF HEALTH PROFESSIONS
EMERGENCY MEDICAL SERVICESDARTON COLLEGE OF HEALTH PROFESSIONSStudent Immunization/Medical Screening RecordLast NameFirst NameMiddle NameStateZipAddressCityInstructions:The Healthcare Provider reviewing the student’s immunization records or providing the vaccinationsshould record the exact dates each immunization/titer was received. This form, with other Orientationmaterials, is required as a prerequisite to beginning clinical rotations.IMMUNIZATIONDATEDATEDATEDATETuberculin Skin TestMeasles/Mumps/RubellaTiterVaricella (Chicken Pox)TiterTdapHepatitis B SeriesTiterSeason Flu VaccinationTuberculin Skin TestREQUIREMENTS & RECOMMENDATIONSAnnual proof of negative TST within 12 months OR if the personhas a history of a positive TST, a chest X-ray report is required.Documentation of 2 MMR vaccines OR a MMR titer validatingimmunity. (It is recommended that the titer be drawn at least 6months prior to starting rotations so that vaccinations can becompleted if titer does not validate immunity.)Documentation of 2 Varicella vaccines OR a Varicella titervalidating immunity. History of the disease does NOT meet therequirements. (It is recommended that the titer be drawn at least6 months prior to starting rotations so that vaccinations can becompleted if titer does not validate immunity.)Tetanus/Diphtheria/Pertussis – One adult booster after 10 years.(Even if a Td has been received within the previous 5 – 10 years, aTdap containing the Pertussis component is required.)Documentation of all 3 vaccinations in the Hepatitis B series.(Students may begin clinical rotations after the first vaccine in theseries has been administered. Students who fail to adhere to thevaccination schedule will be removed from clinical rotations.)Students must provide proof that the current year’s Influenzavaccination has been completed by October 31st of eachacademic year.Annual proof of negative TST within 12 months OR if the personhas a history of a positive TST, a chest X-ray report is required.(Individual clinical sites may impose additional immunization requirements)Name of Clinic or AgencyContact Information of Provider (Telephone/Email)Print Name of Healthcare Completing the Review/ValidationDateSignature of Provider/Reviewer
_ Original Darton College of Health Professions Immunization Form Please mail completed EMS application materials to: Rhonda Hunt Emergency Medical Services Program Darton College of Health Professions ASU-West Campus 2400 Gillionville Rd Albany, GA 31707 229-500-2241 / 478-256-5495 rhonda.hunt@asurams.edu
