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EMS Program Application

Please complete the form below for application to the EMS Program. Answers to all items are required. If a question does not pertain to you, simply put NA for the response. Upon submission of the form, you will be contacted by the EMS Director to review and complete the application process.

Admission to the Galveston College EMS Program requires a minimum current GPA of 2.0.

Please select the EMS program you are applying for.

A.A.S. Program

Certificate Only Program

Emergency Medical Services

Current status:

Application date:

Applying for semester:


Preferred days of the week and times for class:

Student ID Number:

Social Security Number* (may require documentation):
Will be collected by EMS Director upon application completion.

Date of Birth (may require documentation)

Last Name

First Name

Middle/Other Name




Zip Code


Phone Number

I understand that falsifying any information on the application form may result in my application being denied and/or dismissal from the program.

*Social Security number is required.
**EMT Certification required and copy of certificate.

Contact Emergency Medical Services

Brian Ayres
Program Director





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