Education

-Educators workshop request for approval

The forms below are only available through the KBEMS Licensing Portal. All forms links in this section will redirect to the Kansas Board of EMS Licensing Portal. Paper/PDF applications will no longer be accepted.

-Request for Initial Course Approval
-Request for Initial Course Approval–Educator
-Single Program Provider Form
-Retro-active approval for EMS continuing education
-Sponsoring Organization Application
-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

Beginning on December 31st, 2021 EMS Providers holding Current Kansas EMS certification can apply for Inactive Ineligible to Practice certification. This allows providers who are no longer providing EMS services to retain their certification without the need to complete continuing education. Complete the form below and send to the Board of EMS, along with the $10 fee to change your status to “Inactive Ineligible to Practice”. If you decide to return to active status, you will be able to reinstate your certification by submitting a reinstatement application, completing the required Continuing Education, and payment of the applicable fee.

Click the link to download the Inactive Status Request application.

Note: All Certification Applications are available on the KBEMS Licensing Portal. All forms links in this section will redirect to the Kansas Board of EMS Licensing Portal. Paper/PDF forms will no longer be accepted for processing.
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

-Medical Director Appointment Form
-Tag Authorization Form
-Authorization for Release of Information
-AED Placement Notification Form
-Variance Application

The forms below are only available through the KBEMS Licensing Portal. All forms links in this section will redirect to the Kansas Board of EMS Licensing Portal. Paper/PDF applications will no longer be accepted.

-Investigations Self-report Form
-Felony Conviction Questionnaire
-Other Allied Health Personnel Form, NOTE: Allied Health Personnel may need to create an account in the Licensing Portal.