LSC - North Harris EMT - Basic Program Application

First Name *

Last Name *

Address *

Address 2

City *

State/Province *

Zip/Postal Code *

Phone *

Email Address *

Lone Star College ID Number *

Social Security Number *

Date of Birth * +

Please select a location. *

Terms and Conditions *

You consent to receive communications from us electronically. We will communicate with you by e-mail or phone. You agree that all agreements, notices, disclosures and other communications that we provide to you electronically satisfy any legal requirement that such communications be in writing.

Criminal History, Medical Document Manager and Drug Screen *

I understand I must complete a criminal background check, drug screen, and upload shot records to a medical document manager. This must be completed prior to registration approval.

Please sign *

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