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Paramedic Application

Paramedic Program Application

OFFICIAL TRANSCRIPTS must be mailed to the Office of Enrollment Services (Admissions and Records).  All schools and colleges attended must be listed for the application to be complete.  If necessary, use additional sheets.

The Paramedic Program is one year (3 semesters) and offered every year beginning in the Fall Semester.*
Did you graduate?
Did you graduate?
Did you graduate?
Status:
Status:
CRIMINAL BACKGROUND CHECKS

Gulf Coast State College (GCSC) students who are granted conditional acceptance into the EMT/Paramedic program must receive a satisfactory criminal background check prior to final acceptance. The background check will be scheduled and performed by the GCSC. Information and instructions on how to complete the background check will be sent by the program coordinator. Criminal background checks performed through other agencies will not be accepted.  Various clinical sites require level two background checks. Clinical agencies may require an additional background check prior to clinical access.  It is possible to graduate from a program at GCSC but be denied the opportunity for licensure because of an unfavorable background check.

Please read the following information carefully

Any student who has been found guilty of, regardless of adjudication, or entered a plea of guilty or nolo contendere to any offense under the provision of 456.0635 (see below) may be disqualified from admission to any EMS program.  In addition to these specific convictions, there are other crimes which may disqualify applicants from entering the EMS programs and/or clinical rotations. The statute can be found online at:

https://www.flsenate.gov/Laws/Statutes/2020/456.0635

456.0635 Health care fraud; disqualification for license, certificate, or registration

(1) Health care fraud in the practice of a health care profession is prohibited.

(2) Each board within the jurisdiction of the department, or the department if there is no board, shall refuse to admit a candidate to any examination and refuse to issue a license, certificate, or registration to any applicant if the candidate or applicant or any principal, officer, agent, managing employee, or affiliated person of the candidate or applicant:

(a) Has been convicted of, or entered a plea of guilty or nolo contendere to, regardless of adjudication, a felony under chapter 409, chapter 817, or chapter 893, or a similar felony offense committed in another state or jurisdiction, unless the candidate or applicant has successfully completed a pretrial diversion or drug court program for that felony and provides proof that the plea has been withdrawn or the charges have been dismissed. Any such conviction or plea shall exclude the applicant or candidate from licensure, examination, certification, or registration unless the sentence and any subsequent period of probation for such conviction or plea ended:

1. For felonies of the first or second degree, more than 15 years before the date of application.

2. For felonies of the third degree, more than 10 years before the date of application, except for felonies of the third degree under s. 893.13(6)(a).

3. For felonies of the third degree under s. 893.13(6)(a), more than 5 years before the date of application;

(b) Has been convicted of, or entered a plea of guilty or nolo contendere to, regardless of adjudication, a felony under 21 U.S.C. ss. 801-970, or 42 U.S.C. ss. 1395-1396, unless the sentence and any subsequent period of probation for such conviction or plea ended more than 15 years before the date of the application;

(c) Has been terminated for cause from the Florida Medicaid program pursuant to s. 409.913, unless the candidate or applicant has been in good standing with the Florida Medicaid program for the most recent 5 years;

(d) Has been terminated for cause, pursuant to the appeals procedures established by the state, from any other state Medicaid program, unless the candidate or applicant has been in good standing with a state Medicaid program for the most recent 5 years and the termination occurred at least 20 years before the date of the application; or

(e) Is currently listed on the United States Department of Health and Human Services Office of Inspector General’s List of Excluded Individuals and Entities, except when such applicant is listed solely based on a default or delinquency on a student loan as provided in s. 120.82.

Agreement of Background Check*
I fully understand I am being considered for the Paramedic Program at Gulf Coast State College. I understand I will not be accepted into the program if I have a previous medical licensure that has been revoked or suspended.
Agreement of Previously Licensure Notification*
First and Last Name

 

I hereby certify that the information contained in this application is true and complete to the best of my knowledge.  I understand that any misrepresentation, omission or falsification of information is cause for denial of admission to the program.  I understand that illegal use, possession, and/or misuse of drugs are reasons for immediate dismissal from any programs in the Public Safety Division.  I further understand that background checks and drug screening are routinely required at most clinical facilities prior to the student being allowed clinical placement.

Gulf Coast State College does not discriminate against any person in its programs, activities, policies or procedures on the basis of race, ethnicity, color, national origin, marital status, religion, age, gender, sex, pregnancy, sexual orientation, gender identity, genetic information, disability, or veteran status. All questions or inquiries regarding compliance with laws relating to non-discrimination and all complaints regarding sexual misconduct or discrimination, may be directed to Lee Wood, Executive Director, Human Resources/Title II/504/Title IX Coordinator and Employment Equity Officer, Gulf Coast State College, 5230 W. US Highway 98, Panama City, FL 32401.