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. 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

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
-Sponsoring Organization Update Form
-Variance Application
-Other Allied Health Personnel Form, NOTE: Allied Health Personnel may need to create an account in the Licensing Portal.