Forms
Education
Note: All Educator Forms are available on the KBEMS Licensing Portal
-Request for Initial Course Approval
-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
Note: All Certification Applications are available on the KBEMS Licensing Portal.
EMS Provider Renewal Application
Educator Renewal Application
-Military Reinstatement Form
-Instructor Coordinator Regain Application
-Application to Re-Instate an Expired Certification Packet
Ambulance Forms
-Vehicle Mech. & Safety Inspection
-Ground Ambulance Inspection
-Air Ambulance Inspection
-Service Inspection
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
