Forms

Education

NOTE: All educator forms are available on the KBEMS licensing portal

-Request for Initial Course Approval–Basic
-Request for Initial Course Approval–Advanced
-Request for Initial Course Approval–Educator
-Single Program Provider Form
-Retro-active approval for EMS continuing education
-Educators workshop request for approval
-Application for Program Provider Status

Educational Incentive Grant

-MOA for Student (Paramedic)Form
-MOA for Student (EMR, EMT, AEMT)

-MOA for Student (Educators)

-MOA for Service Form

-Application for Funds
-EIG Fulfillment Form
-EIG Fulfillment Form – Paramedics
-EIG Fulfillment Form – Educators
-EIG Military & Low Income Request for Funding

Certification

Attendant Renewal Application
Educator Renewal Application
-Military Reinstatement Form
-Instructor Coordinator Initial Application

-Application to Re-Instate an Expired Certification Packet
-Recognition of Non-Kansas Credentials

Ambulance Forms

-Vehicle Mech. & Safety Inspection
-Ground Ambulance Inspection
-Air Ambulance Inspection
-Service Inspection
-Application for Ambulance License (Ground)
-Application for Ambulance License (Air)

Other Forms

-Investigations Self-report Form
-Medical Director Appointment Form
-AED Placement Notification Form
-Felony Conviction Questionnaire
-Authorization for Release of Information
-Sponsoring Organization Update Form
-Variance Application
-Tag Authorization Form
-Other Allied Health Personnel Form
-EMS Voluntary Recognition Audit Form