{"id":54,"date":"2009-06-08T16:15:12","date_gmt":"2009-06-08T20:15:12","guid":{"rendered":"http:\/\/www.ksbems.org\/bems\/?page_id=54"},"modified":"2026-04-02T13:57:39","modified_gmt":"2026-04-02T18:57:39","slug":"forms","status":"publish","type":"page","link":"https:\/\/www.ksbems.org\/ems\/?page_id=54","title":{"rendered":"<h1>Forms<\/h1>"},"content":{"rendered":"<h2>Most forms are now Licensing Portal based<\/h2>\n<p><!--\n\n<h3>Education<\/h3>\n\n --><br \/>\n<!--<a href=\"https:\/\/ksbems.org\/ems\/forms\/Educators_Workshop.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">-Educators workshop request for approval<\/a>--><\/p>\n<p><!--  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.\n\n<a href=\"https:\/\/www.kemsis.org\/lms\/public\/portal#\/login target=\"_blank\" rel=\"noopener noreferrer\">-Request for Initial Course Approval<\/a>\n<a href=\"https:\/\/www.kemsis.org\/lms\/public\/portal#\/login target=\"_blank\" rel=\"noopener noreferrer\">-Request for Initial Course Approval--Educator<\/a>\n<a href=\"https:\/\/www.kemsis.org\/lms\/public\/portal#\/login target=\"_blank\" rel=\"noopener noreferrer\">-Single Program Provider Form<\/a>\n<a href=\"https:\/\/www.kemsis.org\/lms\/public\/portal#\/login target=\"_blank\" rel=\"noopener noreferrer\">-Retro-active approval for EMS continuing education<\/a>\n<a href=\"https:\/\/www.kemsis.org\/lms\/public\/portal#\/login\" target=\"_blank\" rel=\"noopener noreferrer\">-Sponsoring Organization Application<\/a>\n<a href=\"https:\/\/www.kemsis.org\/lms\/public\/portal#\/login\" target=\"_blank\" rel=\"noopener noreferrer\">-Application for Program Provider Status<\/a> --><br \/>\n<!-- Removed these forms:\n<a href=\"https:\/\/ksbems.org\/ems\/forms\/Initial_appl_form.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">-Request for Initial Course Approval<\/a>\n<a href=\"https:\/\/ksbems.org\/ems\/forms\/Initial_course_approval_educator.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">-Request for Initial Course Approval--Educator<\/a>\n<a href=\"https:\/\/ksbems.org\/ems\/forms\/Single%20Program%20Provider%20Form.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">-Single Program Provider Form<\/a>\n<a href=\"https:\/\/ksbems.org\/ems\/forms\/Retro-active%20Approval%20for%20CE.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">-Retro-active approval for EMS continuing education<\/a>\n<a href=\"https:\/\/ksbems.org\/ems\/forms\/App_prog_provid.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">-Application for Program Provider Status<\/a>\n--><\/p>\n<h3>Educational Incentive Grant<\/h3>\n<p><a href=\"https:\/\/ksbems.org\/ems\/forms\/MOA for Student for Paramedic1.pdf\" rel=\"noopener noreferrer\">-MOA for Student (Paramedic)Form<\/a><br \/>\n<a href=\"https:\/\/ksbems.org\/ems\/forms\/MOA for Student for EMR EMT AEMT1.pdf\" rel=\"noopener noreferrer\">-MOA for Student (EMR, EMT, AEMT)<\/a><br \/>\n<a href=\"https:\/\/ksbems.org\/ems\/forms\/MOA for Services1.pdf\" rel=\"noopener noreferrer\">-MOA for Service Form<\/a><br \/>\n<a href=\"https:\/\/www.ksbems.org\/ems\/forms\/EIG Request for Funding.pdf ?ver=23.12\" rel=\"noopener noreferrer\">-Application for Funds <\/a><br \/>\n<a href=\"https:\/\/www.ksbems.org\/ems\/forms\/EIG Obligation Fulfillment form1.pdf\" rel=\"noopener noreferrer\">-EIG Fulfillment Form<\/a><br \/>\n<a href=\"https:\/\/www.ksbems.org\/ems\/forms\/EIG%20Obligation%20Fulfillment%20form Paramedic1.pdf\" rel=\"noopener noreferrer\">-EIG Fulfillment Form &#8211; Paramedics<\/a><br \/>\n<a href=\"https:\/\/www.ksbems.org\/ems\/forms\/EIG Military &amp; Low Income Request for Funding1.pdf\" rel=\"noopener noreferrer\">-EIG Military &amp; Low Income Request for Funding<\/a><br \/>\n<!--\n\n<h3>Certification<\/h3>\n\n\nBeginning 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.  Submit an application through the portal, 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.\n\nA link to the portal is here: <a href=\"\/\/www.kemsis.org\/lms\/public\/portal#\/login\" target=\"_blank\" rel=\"noopener noreferrer\">Inactive Status Request application<\/a>.\n\nNote: All Certification Applications are available on the <a href=\"https:\/\/www.kemsis.org\/lms\/public\/portal#\/login\" target=\"_blank\" rel=\"noopener noreferrer\">KBEMS Licensing Portal<\/a>. 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. --><br \/>\n<!-- <a href=\"https:\/\/www.kemsis.org\/lms\/public\/portal#\/login\" target=\"_blank\" rel=\"noopener noreferrer\">EMS Provider Renewal Application<\/a>--><br \/>\n<!-- <a href=\"https:\/\/www.kemsis.org\/lms\/public\/portal#\/login\" target=\"_blank\" rel=\"noopener noreferrer\">-Educator Renewal Application<\/a>\n<a href=\"https:\/\/www.kemsis.org\/lms\/public\/portal#\/login\" target=\"_blank\" rel=\"noopener noreferrer\">-Military Reinstatement Form<\/a>\n<a href=\"https:\/\/www.kemsis.org\/lms\/public\/portal#\/login\" target=\"_blank\" rel=\"noopener noreferrer\">-Inactive Status Request application<\/a>.\n<a href=\"https:\/\/www.kemsis.org\/lms\/public\/portal#\/login\" target=\"_blank\" rel=\"noopener noreferrer\">-Application to Re-Instate an Expired Certification Packet <\/a> --><\/p>\n<h3>Ambulance Forms<\/h3>\n<p><a href=\"https:\/\/ksbems.org\/ems\/forms\/Vehicle_safety_mech_inspection.pdf\" rel=\"noopener noreferrer\">-Vehicle Mech. &amp; Safety Inspection<\/a><\/p>\n<p>As the actual ambulance and service inspections change on a regular basis, the PDF version of the inspection forms is no longer available.<br \/>\n<!--<a href=\"https:\/\/ksbems.org\/ems\/forms\/AmbulanceInspection.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">-Ground Ambulance Inspection<\/a>\n<a href=\"https:\/\/ksbems.org\/ems\/forms\/AirAmbulance.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">-Air Ambulance Inspection<\/a>\n<a href=\"https:\/\/ksbems.org\/ems\/forms\/ServiceInspection.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">-Service Inspection<\/a>--><br \/>\n<!--<a href=\"https:\/\/ksbems.org\/ems\/forms\/App_amb_license.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">-Application for Ambulance License (Ground)\n<\/a><a href=\"https:\/\/ksbems.org\/ems\/forms\/Application_Air_Ambulance_License.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">-Application for Ambulance License (Air)<\/a> --><\/p>\n<h3>Other Forms<\/h3>\n<p><a href=\"https:\/\/ksbems.org\/ems\/forms\/Medical Director.pdf\" rel=\"noopener noreferrer\">-Medical Director Appointment Form<\/a><br \/>\n<a href=\"https:\/\/ksbems.org\/ems\/forms\/Tag_Authorization_Form.pdf\" rel=\"noopener noreferrer\">-Tag Authorization Form<\/a><br \/>\n<!-- <a href=\"https:\/\/ksbems.org\/ems\/forms\/release_info.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">-Authorization for Release of Information<\/a>\n<a href=\"https:\/\/aedregistry.pulsepoint.org\/index.php\" target=\"_blank\" rel=\"noopener noreferrer\">-AED Placement Notification<\/a> --><br \/>\n<!--<a href=\"https:\/\/www.ksbems.org\/ems\/forms\/variance-application jrb.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">-Variance Application<\/a>--><\/p>\n<p><!-- The forms below are only available through the <a href=\"https:\/\/www.kemsis.org\/lms\/public\/portal#\/login\" target=\"_blank\" rel=\"noopener noreferrer\">KBEMS Licensing Portal<\/a>. All forms links in this section will redirect to the Kansas Board of EMS Licensing Portal. Paper\/PDF applications will no longer be accepted.\n\n<a href=\"https:\/\/www.kemsis.org\/lms\/public\/portal#\/login\" target=\"_blank\" rel=\"noopener noreferrer\">-Investigations Self-report Form<\/a>\n<a href=\"https:\/\/www.kemsis.org\/lms\/public\/portal#\/login\" target=\"_blank\" rel=\"noopener noreferrer\">-Felony Conviction Questionnaire<\/a>\n<a href=\"https:\/\/www.kemsis.org\/lms\/public\/portal#\/login\" target=\"_blank\" rel=\"noopener noreferrer\">-Other Allied Health Personnel Form<\/a>, NOTE: Allied Health Personnel may need to create an account in the Licensing Portal. --><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Most forms are now Licensing Portal based Educational Incentive Grant -MOA for Student (Paramedic)Form -MOA for Student (EMR, EMT, AEMT) -MOA for Service Form -Application for Funds -EIG Fulfillment Form [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":437,"menu_order":3,"comment_status":"closed","ping_status":"open","template":"","meta":{"_crdt_document":"","ngg_post_thumbnail":0,"footnotes":"","_links_to":"","_links_to_target":""},"class_list":["post-54","page","type-page","status-publish","hentry"],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.ksbems.org\/ems\/index.php?rest_route=\/wp\/v2\/pages\/54","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.ksbems.org\/ems\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.ksbems.org\/ems\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.ksbems.org\/ems\/index.php?rest_route=\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.ksbems.org\/ems\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=54"}],"version-history":[{"count":98,"href":"https:\/\/www.ksbems.org\/ems\/index.php?rest_route=\/wp\/v2\/pages\/54\/revisions"}],"predecessor-version":[{"id":6645,"href":"https:\/\/www.ksbems.org\/ems\/index.php?rest_route=\/wp\/v2\/pages\/54\/revisions\/6645"}],"up":[{"embeddable":true,"href":"https:\/\/www.ksbems.org\/ems\/index.php?rest_route=\/wp\/v2\/pages\/437"}],"wp:attachment":[{"href":"https:\/\/www.ksbems.org\/ems\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=54"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}