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First Name:
Last Name:
Address:
City:
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Postal Code:
Country:
Phone Number:
Mobile Number:
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Gender: MaleFemaleOther
Date of Birth:
High School Diploma Awarded: YesNo
High School Attended:
Province and/or County:
Graduation Date or Last Date Attended:
Did you graduate with Academic (or higher) Math at grade 11? YesNo
Did you graduate with Academic (or higher) Math at grade 12? YesNo
Did you graduate with Academic (or higher) Biology, Chemistry or Physics Grade 11? YesNo
Did you graduate with Academic (or higher) Biology, Chemistry or Physics Grade 12? YesNo
Did you graduate with Academic (or higher) English at grade 11? YesNo
Did you graduate with Academic (or higher) English at grade 12? YesNo
Are you applying as a Mature Student? A Mature Student is an applicant who does not meet the basic admission requirements. Mature student status will be granted to an applicant provided the following conditions are met: i. The applicant is at least 21 years of age and has been out of school for a minimum of one year. ii. The applicant participates in an interview process with a designated admissions representative. In the process of the interview, the applicant will be required by the college to provide the following supporting documentation: 1. Letter outlining future plans and the reasons they expect to successfully complete the program of studies 2. Personal resume 3. Letters of reference (3) iii. The applicant will be required to complete the Canadian Adult Achievement Test (CAAT). YesNo
Is English or French your first Language? If no, proof of English or French language proficiency will be required (official marks are required from the testing company) Our language proficiency requirements: i. A Test of English as a Foreign Language (TOEFL) (iBT) score must be at 96 overall with no less than 24 in each band. ii. A International English Language Testing System (IELTS) must be at 7 overall with no less than 7 in all bands. YesNo
Have you attended another paramedic program previously? YesNo
If yes, which institution?
Date of withdrawal
If yes, where? Official Transcripts of all previous college and university studies are required. Transcripts for Medavie HealthEd, the former Atlantic Paramedic Academy and former Maritime School of Paramedicine are on file.
College / University Attended:
From:
To:
Degree / Diploma Obtained:
Master Number:
Class: 12345678
Endorsements: ABCDENone
Our institution has a responsibility to provide a reasonable level of accommodation to students who require consideration for physical and/or learning disabilities.
Do you have any physical or learning requirements that will require accommodation? Not ApplicableYesNo
Are you forwarding documentation with regard to your learning or other disabilities? Not ApplicableYesNo
If you have indicated “Yes” for either of the above options or have any other learning concerns, you must contact our institution for further guidance. Please note if a physical or learning disability exists that requires accommodation and it is not disclosed during the application process we cannot guarantee enrollment.
I hereby certify that all of the above information and all supporting documentation is complete and correct. I authorize Medavie HealthEd to verify any information provided as part of this application. I understand that withholding information or providing false information in this application and/or any supporting documentation may be considered grounds for non-acceptance, or after acceptance, grounds for dismissal. I agree to follow and be bound by the regulations of Medavie HealthEd, including any revisions, deletions or additions made to them in the future. If admitted I agree to pay all associated fees with my enrolment and the program.
Signature:
Date:
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