Applications were due by September 30, 2013
FIRST RESPONDER/EMT TRAINING SUBSIDY APPLICATION FOR TRAINING FUNDS
July 1, 2013 - June 20, 2014
Regional EMS funds are again available to official First Responder Squads in Southeastern Minnesota for the following courses: First Responder Certification, First Responder Recertification, Emergency Medical Technician Certification, and Emergency Medical Technician Recertification. A squad can apply for EMS funds to meet the training needs of both new and current members. Following is the allocation per person for each program:
First Responder Certification ($175)
First Responder Recertification ($100)
EMT Certification ($300)
EMT Recertification ($125)
BLS ambulance services who have a hardship variance and are using First Responders on their service CAN apply for the FR training funds! They are not, however, eligible for the EMT training funds because that is available through the EMSRB. Ambulance services only need to complete contact info and # to be trained.
NOTE: Acceptance of application does not guarantee payment for all requests for reimbursement. Eligible reimbursements are paid on a first come, first served basis until the funds allocated for the fiscal year have been depleted.
Address City State Zip Code County
Daytime Telephone Number Email
Estimated number of individuals to be trained for following classes:
First Responder Certification First Responder Recertification _
EMT Certification EMT Recertification ________
If application is for an existing Squad, complete Section A. If you are seeking funds to offset EMT training, complete Section B.
1. Last First Responder Course offered __________________
2. Training institution __________________
3. Number certified ____________ Current number of members __
4. Approximate number of runs per year _________________
5. Does Squad use run report forms: YES NO Source ____________________
6. Does squad have direct radio communications with ambulance service: YES NO
7. Does Squad have regular meetings/training sessions: YES NO
NOTE: Subsidy is limited to FOUR members per year for EMT Certification OR Recertification. Individuals must have a minimum of TWO YEARS on an official First Responder Squad to be eligible.
8. _________ Circle: EMT or EMT Recert # Years on Squad:_______
First Individual’s Name
9. __________Circle: EMT or EMT Recert # Years on Squad:______
Second Individual’s Name
10. __________Circle: EMT or EMT Recert # Years on Squad:______
Third Individual’s Name
11. __________Circle: EMT or EMT Recert # Years on Squad:______
Fourth Individual’s Name
Application can be returned via email, fax, or mail BEFORE SEPTEMBER 30, 2013.
Revised: June 2013