Course Application | EMTPKY Medical Course Application

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Which class are you applying up for?*

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Hepatitis B Vaccination Statement of Understanding: I understand that due to my probable exposure to blood or other potentially infectious materials during my healthcare training and as an employee in the healthcare field I may be at risk of acquiring the Hepatitis B Virus (HBV). I have been given the opportunity to be vaccinated for HBV at my own expense. I understand that by declining this vaccination I will continue to be at risk of acquiring HBV which is a potentially life threatening disease. I understand that I have the right to change my mind and receive this vaccination at a later date. If I choose to be vaccinated at a later date, I can receive the vaccination series at my own expense; however, I am responsible for providing EMTP with my HBV vaccination records.*
First Last
You must acknowledge the above statement by typing your first and last names in the fields above.
Please select the appropriate line to indicate your current HBV vaccination status.*
- I have been given the opportunity to be vaccinated for the HBV at my own expense; however I decline to obtain the HBV vaccination at this time.
- I do not know if I have been vaccinated for HBV; however I decline to obtain HBV vaccination at this time.
- I have not been vaccinated for HBV but I plan to obtain the vaccination and I will provide EMTP with vaccination records by the deadline mandated within the Student Manual.
- I have been vaccinated for HBV and will provide EMTP with records by the deadline mandated within the Student Manual.

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Do you have a CHI application code?*
- Yes
- No
Enter your CHI code here*
An application fee of $35 will be collected, along with a Credit Card fee of 2.9% +$0.25.
Credit Card*

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Credit Card Billing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Total
Price: $35.00

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Please enter your initials on each line below to acknowledge that you have read, understand and agree to be bound by each statement.
I have made a commitment to EMTP and I will pay my non-refundable deposit and tuition for the program within the time allotted per the student manual.*
- I agree
I understand that I am considered “enrolled” once I submit this Student Application Form or make payment toward my non-refundable deposit.*
- I agree
If I never attend class, I will still be charged for the non-refundable program deposit and possibly an additional processing fee because I made a promise to EMTP that I would attend this course.*
- I agree
I understand that the program deposit, lab fees, uniform shirts and textbooks are non-refundable even if I cancel my enrollment.*
- I agree
If I am rendered ineligible for course completion, quit, fail, cancel my enrollment or I am terminated from the course and I still have a balance due that I must pay the entire balance within 15 days of the last day that I was present in class or make payment arrangements.*
- I agree
I understand that any late fees, interest, and expenses incurred by EMTP or a collections agency while collecting my outstanding balance will be added to my total balance.*
- I agree
If I do not cancel my enrollment within the time frame allotted or if I am terminated for misconduct that I will not be eligible for any tuition refund.*
- I agree
I understand that if I wish to transfer my enrollment to another course or program, I must submit a Student Transfer Application via e-mail (info@emtpky.com) or in person at least twenty-four (24) hours before my scheduled first class session beings. Failure to request a transfer as described above will result in forfeiture of my deposit and I will not be eligible for a deposit transfer.*
- I agree
I understand that if I want to transfer to a different course or program that I must submit a Student Transfer Application via e-mail (info@emtpky.com) or in person before the seventeenth (17th) hour of scheduled classroom instruction time. I will only be eligible for transfer if I am in good standing in the course and I must present documentation to show good cause (reason covered FMLA and/or serious work conflict) for the transfer. Also, I understand that I will be required to submit a $250.00 transfer fee to complete my request. Failure to request a transfer as described above will result in forfeiture of my deposit and I will not be eligible for a class transfer.*
- I agree
I attest that all information on this application is complete and accurate. Withholding or providing false information will render me ineligible for course completion, course transfer, and/or deposit transfer.*

Please type your full name in the blank above as your electronic signature.
Date*
EMTP will reimburse a student’s tuition and deposit IF the school moves a program start date and the previously enrolled student cancels enrollment because the newly scheduled date is not suitable. Contact EMTP (info@emtpky.com) or consult the student manual for more detailed information regarding the EMTP tuition refund policy.
Name
This field is for validation purposes and should be left unchanged.

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