RE: Paramedic Program Fall 2012

Dear Prospective Student:

Thank you for your interest in the Malcolm X College Paramedic Program.

Enclosed is the application packet for the Program starting fall semester 2012. The Program runs for one year, beginning with the fall 2012 semester and continuing through summer semester 2013. Classes meet on Mondays & Wednesdays from 9:30AM to 2:00PM and on Fridays from 9:30AM to 4:20PM. These dates and times may be variable and do not include Clinical Rotations or Internship Assignments.

Please read the following enclosed instructions carefully. Incomplete or inaccurate applications will jeopardize your consideration as a candidate for the program. Also take note of the admission requirements which includes a college level Anatomy and Physiology course. The deadline to submit the application is no later than Friday, April 27, 2012 at 4:00 p.m.

Candidate selections are made by interview process. Interviews are granted to students who submitted a complete application before the deadline and attain acceptable scores on the entrance exam. Interviews will be scheduled between May 21st and June 16th.

If you have any questions, please call the EMS office at 312-850-7124.

Sincerely,

Susan Santacaterina, MHPEDirector, Paramedic Program

PARAMEDIC PROGRAM – APPLICATION DOCUMENTS

Below is a list outlining the documents enclosed in the application packet:

A. Information documents – In addition to the application packet, you will find the following information:1. Paramedic Program Description - Program description and admission requirements.

2. Frequently Asked Questions (FAQ) - Information regarding program application and estimated cost.

3. EMT Refresher Course –This course is OPTIONAL and is available to those students who wish to refresh skills and knowledge prior to sitting for entrance exam.

4. Timeline – Dates and deadlines for application process.

5. Testing Dates – All students are required to take EMT entrance exams. Some students will also be required to take COMPASS placement exams in reading and/or math.

B. Application Forms – The following documents are to be completed and returned as per instructions.

1. Paramedic Program Application form – Complete and sign. An application fee of $35.00 must be submitted with application packet in the form of a Cashier’s Check or Money Order made payable to the Malcolm X College Paramedic Program. Applicants must attach clean copies of the following items: A current Illinois EMT-B license CPR Healthcare Provider card (both sides) An identifiable Driver’s License or State I.D.

2. Transcript Information Officia l college (or high school transcripts if no college background) must be sent to Malcolm X

College Office of the Registrar, unless you are currently enrolled as a MXC student. Include an unofficial copy of all transcripts with the completed application packet that is returned to

the EMS Department. There must be validation of successful completion (C minimum) of a college level Anatomy and

Physiology class, 4 credit hours with a lab. BIO 116, 226, 227 are acceptable.

3. Paramedic Entrance Exams – This handout provides you with information and dates available to take the Paramedic Entrance Exams. This is mandatory!

4. Verification of Field Experience – Return the form completed by your employer validating work experience as an EMT.

5. Recommendation Forms (3) – Provide personal and professional recommendations from three different sources. Spouse or family relative cannot submit these recommendations. These forms can be mailed directly to the MXC EMS Program Office or the recommendation can be placed in a sealed envelope with the author’s signature written across the seal, and included with the completed application packet. It is the responsibility of the applicant to make sure all 3 recommendations have been submitted. Fax copies are unacceptable.

6. Personal Statement Form – Provide a personal statement expressing your reasons for making application to the program. No more than two pages, legible please.

7. Checklist – Return the provided checklist to make sure your application is complete. Make certain you identify your requested reservation dates for taking the Paramedic Entrance Exams. Sign where indicated on checklist.

Completed applications are to be submitted to:

Malcolm X CollegeEMS Program Office - Room #2621

1900 W. Van Buren Street

Chicago, IL. 60612

The deadline for return of completed application is:

Friday, April 27, 2012 at 4:00 pm.

CITY COLLEGES OF CHICAGOMALCOLM X

PARAMEDIC PROGRAM DESCRIPTION

Malcolm X College (MXC) offers an educational program for licensed Emergency Medical Technicians looking to expand their career as a Paramedic.

This program has been developed by the City of Chicago Emergency Medical Service System (Region XI), which is a collaborative effort by Malcolm X College, Chicago Fire Department and the Chicago Resource Hospitals: Advocate Illinois Masonic Medical Center, Stroger Hospital of Cook County, Northwestern Memorial Hospital and the University of Chicago Hospitals. The Paramedic Program is approved by the Illinois Department of Public Health, Division of Emergency Medical Services and Highway Safety.

In addition to the Paramedic Core Curriculum, Malcolm X College is one of the few colleges in Illinois to offer an Associate in Applied Science Degree (AAS) in this professional specialty. Successful completion of this program’s core curriculum provides eligibility to take the licensing examination offered by the Illinois Department of Public Health or the National Registry. Completion of the Associate in Applied Science Degree can broaden the student’s marketability, as well as provide a strong basis for continued professional learning.

ADMISSION REQUIREMENTS

The Paramedic Program courses run for three consecutive semesters. The Program begins in the Fall Semester of each year. Annual applications are made available in early February and due in late April.

To be considered for admission the applicant must:

Be a high school graduate or GED Certificate holder Be currently licensed by the State of Illinois as an EMT-B (Note – students enrolled in a current Spring

Semester EMT class who have not completed state exam are not eligible to apply (unless you are from the MXC EMT spring class with acceptable course grade)

Successfully complete a college level Anatomy and Physiology course that is 4 credit hours with a lab Have a current CPR healthcare provider card Achieve acceptable scores on admissions examinations Submit a complete application, with transcripts by the stated deadline. Field experience as an EMT is strongly recommended

Applicant Interviews - Interviews with Chicago EMS Region XI Admissions Committee will be granted those applicants who meet the Malcolm X College Paramedic Program admission requirements. Selection of candidates for this program is highly competitive. Candidate selections are based on interview results, academic history/GPA, admission testing results, EMS work experience, references, and commitment to the community.

Paramedic Core Curriculum

The Paramedic Program runs three consecutive semesters starting in the fall of each year. Successful completion of the Paramedic Core Curriculum provides an Advanced Certificate in Paramedic level of training, and eligibility to take the licensing examination offered by the Illinois Department of Public Health or the National Registry.

Fall Semester:EMT 221 Essentials of Paramedic Medicine I 9 Credit HoursEMT 222 Paramedic Medicine Practicum I 5 Credit Hours

Spring Semester:EMT 223 Essentials of Paramedic Medicine II 9 Credit HoursEMT 224 Paramedic Medicine Practicum II 5 Credit Hours

Summer Semester:EMT 227 Paramedic Field Internship 6 Credit Hours Total Credit Hours in Major (Core): 34 Credit Hours

Associate in Applied Science Degree

Requirements for the Associate in Applied Science Degree – Paramedic includes a minimum of 61 credit hours with at least 34 hours concentrated in the major (Core). Refer to the college catalogue for more detailed information. http://ccc.edu/menu/Pages/Academic-Catalog.aspx

General Education Courses:

English 101 3 Credit HoursBiology 120 3 Credit HoursSociology 201 3 Credit Hours Psychology 201 3 Credit HoursCommunications elective 3 Credit HoursSocial Science electives 5 Credit HoursHumanities/Fine Arts elective 3 Credit HoursPhysical/Life Sciences elective 4 Credit Hours

Total Credit Hours in General Education: 27 Credit HoursTotal Credit Hours Required for AAS: 61 Credit Hours

For more information call or write:Malcolm X College EMS Program Office, Room 26211900 W. Van Buren Street, Chicago, IL. 60612EMS Office: 312-850-7124Paramedic Program Director, Susan Santacaterina - 312- 850-7303

EMT-B Program Director, Tony Scipione - 312- 850-7410CITY COLLEGES OF CHICAGO

MALCOLM X

Paramedic Program

Frequently Asked Questions:

How many candidates typically apply for the MXC program?There are typically three applicants for each class “seat”.

I know qualified candidates need to be interviewed, who are the interviewers and how do they make selections?The interviews are conducted by the admissions committee which is made up of representatives of: Malcolm X College; Chicago Resource Hospitals; Chicago Fire Department; and a Field Paramedic. The committee will ask questions of the candidate that address, and may not be limited to: Qualities such as motivation, maturity, academic capabilities, community commitment; and provide a BLS patient scenario for the applicant to manage. The admission committee will look at all components of the application, including academic history, recommendations, personal statement, test scores and work history.

Is there any advantage to taking the EMT class at Malcolm X College?Students who are already enrolled at Malcolm X College have their academic history readily available to the committee and do not need to make application to the college. Students from MXC, only, are allowed to sit for an interview with a state license “pending” (enrolled in the current Spring EMT class).

How much ambulance experience do I need?The committee strongly recommends working experience as an EMT-Basic by the start of the program (fall semester). Typically 500 hours of field experience is preferred. Documented ambulance experience is not required at the time of interview, however given the competitive application process, field experience as an EMT will provide an advantage for the candidate.

Are there any science prerequisites?Yes! The applicant must have successfully completed a college level Anatomy & Physiology (A&P) course, of 4 credit hours with a lab. Courses offered at CCC which meet this requirement include BIO 116, 226 or 227. If A&P was taken at another college it is advisable that a copy of the course description be reviewed by the program director to assure it meets the requirement. An official transcript must be sent or handed over to the Office of the Registrar, include a copy of the transcript with your completed application packet.

What is acceptable score on the entrance exams?The applicant must achieve a score of 75% on the EMT entrance test (multiple choice) to be eligible for interview. First time applicants to the college must take placement exams in reading and math. The EMS Department offers an EMT-B Refresher Course (not mandatory) prior to Paramedic Program Entrance Testing.

Are there any other characteristics or qualities that can make my application more competitive? As a community college, we look for candidates that appreciate the college mission and demonstrate service to the community. As a health career program, we seek candidates with career goals of service as a paramedic.

When are applications available and when are they supposed to be completed?Applications are available yearly in early February and due in late April. Specific deadlines are clearly stated in the application packet. They can be mailed out, picked up from the EMS Office (Rm.2621), or emailed to you.

What is the cost of the program? See reverse side.

CITY COLLEGES OF CHICAGOMALCOLM X

Paramedic Program CostList Date: 1-2012

All costs are approximate and are subject to change. Refer to the current Malcolm X College “Student Schedule of Classes” for details http://ccc.edu/departments/Pages/Tuition-and-Fees.aspx . Chicago resident cost applies.

Fall Semester (EMT 221 & EMT 222):

Tuition ($89.00 / credit hour x 14 credit hours) 1246.00Registration Fee 30.00Other Fees – Activity Fee (Full time – 12 or more hours; includesU-Pass. Parking, Technology and other student activities) 170.00Lab Fee: 30.00Clinical Fee: 10.00Book cost (cost is approximate) 270.00Cost of course & credentialing in: ACLS, PEPP, ITLS & State Exam Fee 125.00 (subject to change)Background check (cost is approximate) 50.00Physical exam & blood work 130.00 (cost variable per student) Fall Semester Total Cost 2061.00

Spring Semester (EMT 223 & EMT 224):

Tuition ($89.00 / credit hour x 14 credit hours) 1246.00Registration Fee 30.00Other Fees – Activity Fee (Full time – 12 or more hours; includesU-Pass. Parking, Technology and other student activities) 170.00Lab Fee: 30.00Clinical Fee: 10.00Spring Semester Total Cost 1486.00

Summer Semester (EMT 227):

Tuition ($89.00 / credit hour x 6 credit hours) 534.00Registration Fee 30.00Other Fees – Activity Fee (Part time – Less than 12 hours; includesParking, Technology and other student activities – Does not incl. U-Pass) 50.00Lab Fee: 30.00Internship Fee: 500.00Summer Semester Total Cost: 1144.00

***IMPORTANT: All students are required to carry their own health insurance for the entire duration of the Paramedic Program. The above does not include student health insurance cost.***

Tuition Charge Back (Non-Chicago Residents):

Non-Chicago residents who plan to enroll in any Malcolm X College program and that program is not available at a community college in their district should apply to their local community college board office for tuition charge back at least thirty days prior to the first day of registration – where applicable. Prices are subject to change.

Residents of Illinois living outside of Chicago per credit hour cost: 173.56Non-residents of Illinois per credit hour cost: 230.35

2012/ss

EMT-B REFRESHER TRAININGThis 24 hour EMT-B Refresher Training session is designed to ensure individual competency for the practicing EMT-B. This course will also give the EMT-B, who intends to apply to the Malcolm X College, Paramedic Program the opportunity to sharpen their knowledge, skills and review the major concepts and interventions as outlined in the DOT, Emergency Medical Technician Basic curriculum.

It is strongly suggested that students review their current EMT-B textbook prior to class. A minimum grade of 70% on the EMT-B post test and full attendance will ensure the full 24 hour Continuing Medical Education (CME) credits. The course is approved by the Illinois Department of Public Health and hour for hour CME will be awarded.

Class Logistics

Dates: Saturday, April 14, 2012Saturday, April 21, 2012 Saturday, April 28, 2012

Time: 9:00 am to 5:00 pmStudents will be given breaks. Lunch is on your own.

Location: Malcolm X College1900 West Van BurenChicago, Illinois 60612 Room: 2619

Fee: $135.00

Note: Bring your EMT-B textbook to class

Registration:

To register for the EMT-B Refresher Training course, report to the Continuing Education Office in room 2224, Monday thru Thursday 9am to 5:00pm and Friday 9:00am to 4:30pm. Bring a State ID or Illinois Drivers License as proof of residence. After completing the registration form you will be enrolled in the class at which time you will report to the Business Office to pay your $135.00 fee. Registrations will be taken up to and including Friday, March 30, 2012.

If there are any questions or concerns, feel free to contact the EMS Program Office at 312 850 7410.

Paramedic Program Entrance Exam

Each applicant is required to take an EMT entrance exam. This is a multiple question test; scores on this exam will determine eligibility to sit for a program interview. Applicants must request a date to take this exam by submitting your preferences on the application checklist. You will receive a confirmation by email. Space is limited, so it is important to get the application and test date request submitted early. Applicants must be confirmed to sit for the exam at that specific time.

Taking the Entrance Exam

Prior to taking any exam, the applicant must be admitted to the college for that term. Report to room 1502 and complete a Student Information and Enrollment card. Allow 30-60 minutes to complete this step!

Once you are entered into the system report to the designated area (Rm. 1109 Placement Testing or Rm.2545) to sit for the exam. Please be prompt, allow enough time. No one will be allowed into the testing area once the test begins.

You must present an official, current photo ID to the testing center prior to sitting for exam.

The EMT entrance exam will be offered at the following times:

Test Date Test Time LocationWednesdays April 25, May 2, May 9 10:00 am Rm. 1109Thursdays April 26, May 3, May 10 5:00 pm Rm. 1109Saturday, May 5 10:00 am Rm. 2535

Identify the date and time of your exam reservation on the application checklist.

To enroll in the college, each applicant is required to provide evidence of college level placement in English and Math. Applicants must take COMPASS placement exam levels unless they have demonstrated proficient levels by the following criteria:

COMPASSReading Exam

Current student with acceptable score within past year College transcript indicating successful completion of ENG 101/102

with a grade of “C” or better Comparable ACT scores (19 or greater) taken within 2 years

COMPASS Mathematics Exam

Current student with acceptable score within past year College transcript indicating successful completion of MATH 118 with a

grade of “C” or better Comparable ACT scores (20 or greater) taken within 2 years

Applicants needing to take COMPASS exam must do so prior to fall registration. New students must also attend an orientation prior to taking the COMPASS placement exam. Once you have completed the enrollment card in Rm. 1502 (as described above) you should be in the system and must make arrangements to attend orientation and take placement exams.

Revsd/2012ss

Paramedic Application Timeline – 2012

Open House Dates:

February 1, 2012

1:00pm – 5:00pmRoom 2616

The Paramedic Program will host an Open House for prospective students to pick up an application (or requested/received sooner), meet with instructors and answer any questions regarding the program.

Available Upon Request Application packets available from MXC EMS Department. They can be mailed out or emailed available upon request.

Friday, April 27, 2012No later than 4:00PM

Deadline for completed applications to be submitted

Wednesday, April 25th toThursday, May 10th

Dates for entrance exam are provided in application packet. Space is limited, Reserve testing date with submitted application.

May 7th throughMay 21st

Letters sent out with results of entrance exams and interview dates.

May 28th throughJune 15th

Interviews

Friday, June 22nd Acceptance letters sent out

Friday, July 17th Student confirmations/responses due

Week of August 20th One-day orientation

Monday, August 27th First Day of Class

Malcolm X College One of the City Colleges of Chicago EMS Program Office, Room 2621 1900 W. Van Buren Street Chicago, IL. 60612 (312) 850-7124Paramedic Program Application Information Form: All applicants must fill out the Paramedic Program Application Information Form and return to EMS Program Office. Official college transcripts are to be sent to MXC Office of the Registrar, and copies of transcripts are to be included

with the completed application packet. Application fee of $35.00. Cashier’s checks or money order made payable to Malcolm X College Paramedic Program. Signing this application: Certifies that the facts contained are true and complete to the best of the applicant’s

knowledge, and understand that falsified statements on this application shall be grounds for dismissal from both the application process and/or the Paramedic Program.

ALL required documents must be submitted by the application deadline- April 27, 2012 no later than 4:00PM.

Personal Information (please print or type)Student ID Number (if current mxc student)Click here to enter text.

Date of ApplicationClick here to enter text.

Anticipated Start DateMo. Click here to enter text.

Year Click here to enter text.

Last NameClick here to enter text.

First NameClick here to enter text.

Middle NameClick here to enter text.

Address: Click here to enter text.

Email Address: Click here to enter text.

CityClick here to enter text.

StateClick here to enter text.

Zip codeClick here to enter text.

CountyClick here to enter text.

Home Phone (include area code)Click here to enter text.

Business Phone: (include area code)Click here to enter text.Cell. Phone: (include area code)Click here to enter text.

Emergency Contact: Name, Relationship and Phone #Click here to enter text.

Academic Background - List high school and all colleges or universities attended including any of the City Colleges of Chicago.

High School City State Dates (from/to) Degree Earned

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EMT Program Attended City State Dates (from/to) Degree Earned

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enter text. here to enter text.

College/University City State Dates (from/to) Degree Earned

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Health care work experience: Employer or Dept. Volunteer Click here to enter text.

SupervisorClick here to enter text.

Address Click here to enter text.

PhoneClick here to enter text.

Dates of affiliation (from / to)

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Type of affiliation (paid or volunteer)

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Number of hours weekly

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DutiesClick here to enter text.

Reason for leavingClick here to enter text.

Employer or Dept. Volunteer Click here to enter text.

SupervisorClick here to enter text.

Address Click here to enter text.

PhoneClick here to enter text.

Dates of affiliation (from / to)Click here to enter text.

Type of affiliation (paid or volunteer)Click here to enter text.

Number of hours weeklyClick here to enter text.

DutiesClick here to enter text.

Reason for LeavingClick here to enter text.

Non-health care related work experience:

Employer Position Dates of EmploymentClick here to enter text. Click here to enter text. Click here to enter text.Click here to enter text. Click here to enter text. Click here to enter text.Click here to enter text. Click here to enter text. Click here to enter text.

Licenses / Certifications (include double-sided photocopy of each)

License/certificate State Expiration DateClick here to enter text. Click here to

enter text.Click here to enter text.

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Are you willing to submit to a: Comprehensive medical history and/or exam; Drug screening; Testing for communicable diseases; Immunization (where necessary); Background check and have the results disclosed to the Director, MXC Admission Review Member(s) and Clinical Site Director(s)? ☐ Yes ☐ No

Have you ever been convicted of a crime? ☐ Yes ☐ No

Signature___________________________________ Date_________________Rvsd/2012/ss

Malcolm X CollegeOne of the City Colleges of Chicago

REQUEST FOR COLLEGE/UNIVERSITY TRANSCRIPTINSTRUCTION TO APPLICANT:Please mail your REQUEST FOR TRANSCRIPT OF RECORDS form to your College/University.

RECORDS OFFICE Date of Request:

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Name of School

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AddressClick here to enter text.

City State Zip

☐ Fall/Year ☐ Spring/Year ☐ Summer/Year

I have applied for admission to Malcolm X College and request that you send an official copy of my academic records to:

MALCOLM X COLLEGEOffice of the Registrar, Room 1325

1900 West Van Buren StreetChicago, Illinois 60612

If there is a transcript fee, please contact me and not Malcolm X College. The following information is provided to assist you in identifying my record. My name and other name(s) used when I attended your institution:

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Last First M Other Name(s) Used

Birthdate:Click here to enter text.Social Security Number:Click here to enter text.

Student ID or PeopleSoft Number (If applicable):Click here to enter text.

Dates of Attendance:Click here to enter text. to Click here to enter text.Month/Year Month/Year

Signature:

Address: Click here to enter text.

CityClick here to enter text.StateClick here to enter text. ZipClick here to enter text.

(Area Code) Telephone Number Click here to enter text.

(E-Mail Address)Click here to enter text.

MALCOLM X COLLEGE PARAMEDIC PROGRAMVERIFICATION OF FIELD EXPERIENCE

This document is to verify that the following applicant:

(Applicant’s name)Click here to enter text.

has participated in direct patient care, providing BLS pre-hospital care during

the following period (list dates of employment):

Starting Date:Choose a building block.

Dates: From Click here to enter text.toClick here to enter text.

During this period, this individual worked an average of Click here to enter text. hours perweek.

___________________________________________ NameClick here to enter text.

____________________________________________ Signature

____________________________________________ TitleClick here to enter text.

____________________________________________ CompanyClick here to enter text.

____________________________________________ PhoneClick here to enter text.

Note: This form must be completed and returned with other application materials.Rvsd.2011.pm

MALCOLM X COLLEGEPARAMEDIC PROGRAM

RECOMMENDATION FORMTHREE NEEDED

To the Applicant:

Type or print your name in the space provided and give this form to the individual submitting a recommendation on your behalf. These individuals must have known you for at least 6 months. If possible, utilize your work supervisor, co-worker and/or EMT Instructor/EMS Coordinator. Three (3) recommendation forms are required. The completed forms are to be submitted with application packet in a sealed envelope with signature of the author written across seal. Mail or hand-deliver packets to:

MALCOLM X COLLEGEEMS PROGRAM OFFICE - PARAMEDIC PROGRAM1900 WEST VAN BUREN STREET, ROOM 2621CHICAGO, ILLINOIS 60612

Applicant

Name: Click here to enter text. (First) (Middle) (Last)Address: Click here to enter text.

(Street Address) (City/State) (Zip)

Telephone Number: Click here to enter text.

(Daytime) (Evening)

TO THE RECOMMENDER: The above individual has applied to the Malcolm X CollegeParamedic Program. In order to give the Admissions Committee a complete profile of theapplicant, please answer the following questions. If you have additional information, attach a separate page. Completed recommendations are to be returned to applicant in asealed envelope with your signature written across the seal.

Recommender Information:

Name Click here to enter text. (First) (Middle) (Last)

Address Click here to enter text. (Street Address) (City/State) (Zip)

Telephone: (Home) Click here to enter text. (Work) Click here to enter text.(Pager) Click here to enter text. (Fax)Click here to enter text.

Institution Click here to enter text. Title Click here to enter text.

May we contact you if there are any further questions? Yes ☐ No ☐

1. How long have you known the applicant and in what capacity?Click here to enter text. 2. Please rate the applicant in the following areas using the grading scale below:

5. Excellent ☐ 4. Good☐ 3. Fair☐ 2. Poor☐1. Unknown☐

____ A. Academic potential Click here to enter text.

____ B. Capacity for logical thinking Click here to enter text.

____ C. Ability to work with others Click here to enter text.

____ D. Ability to express ideas verbally

____ E. Ability to express ideas in writing Click here to enter text.

____ F. Motivation Click here to enter text.

____ G. Judgment Click here to enter text.

____ H. Maturity Click here to enter text.

3. What have you observed to be the applicant’s strengths:Click here to enter text.

4. In what way would he/she be an asset to the EMS community:Click here to enter text.

Recommender’s Signature _________________________________________________________________

2011.pm

Malcolm X College - Paramedic ProgramPersonal Statement

Name: Click here to enter text. Date: Click here to enter text.

Candidates must submit a statement no greater than two single side pages in length, describing your career goals and objectives of pursuing paramedicine as your career.

Application ChecklistMake sure you have included all of the following, and include this checklist in the submitted application:

☐Paramedic Program Application – Completed and signed

☐Application fee of $35.00 in the form of cashier’s check or money order made payable to: Malcolm X College Paramedic Program

☐Official transcripts from previous college or high school sent directly to Malcolm X College, Office of the Registrar.

☐Copies of all transcripts (unofficial) must be included in application packet and submitted to the EMS office. Transcripts must include successful completion of 4-credit hour Anatomy and Physiology course with a lab (such as BIO 116, BIO 226, BIO 227).

☐Verification of field experience – completed and signed

☐Recommendation Forms (3) – completed and signed. Applicant can submit recommendation forms with packet, if document is in a sealed envelope with signature of author written across seal. Student is responsible to verify receipt of those recommendations mailed in.

☐Personal Statement Form

☐College Placement Testing:

I do not need to take COMPASS exams because I have submitted transcripts with ENG 101/102, have ACT composite score of 18 or greater (within 2 years), or COMPASS scores within 1 year. sign____________________________

-OR- I will take COMPASS on (date) ______________ sign ____________________________________

☐I would like to request the following testing dates for the Paramedic Entrance Exam:1st choice Click here to enter a date. 2nd choice Click here to enter a date.

email address to send testing date confirmation Click here to enter text.

☐Enclosed a current clean copy of your: IDPH EMT-B License; CPR Healthcare Provider Card; and Driver’s License or State ID

☐Application checklist – completed, signed with requests for testing dates and includedPlease return all completed application paperwork to:

Malcolm X CollegeEMS Program Office – Paramedic Program

Room 26211900 W. Van Buren Street

Chicago, IL 60612