I do hereby certify that:

1. I am the applicant named and that I am requesting admission to the Paramedic Program identified herein;
2. I have read and understand the Paramedic student prerequisites and do hereby meet those prerequisites unless exceptions have been identified above.
3. I understand I must submit proper documentation of physical examination and proof of required vaccinations prior to acceptance;
4. I understand that entrance into the program does not guarantee Paramedic certification;
5. I understand that completion of this education program will not authorize or grant me any right to perform those advanced life support activities in which I will be trained, as these acts are governed by the State. Any right to perform such acts must be acquired only by agreement with a medical advisor and under the authority of his/her medical license;
6. I understand that approved continuing education courses and on-going review and audit with an agency medical director will be part of the requirements necessary to maintain Paramedic certification;
7. I have read all of the above statements and do declare these statements to be true to the best of my knowledge;
8. I understand that all statements made in this application are subject to verification and should falsification of this document be demonstrated, my application shall be considered unacceptable for admission to the Paramedic Program.