October 2024

EMS Corps Program

Fill out this application as COMPLETELY and ACCURATELY as possible.

First Name

Last Name

Address

Address 2

City

Confirm Email

Birthday

How old are you?

Mobile Phone

What is your first language?

County

What is your race/ethnicity? (Hold down control key and click to select multiple race/ethnicity)

If other, please specify.

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Select...
African America or Black - A person having origins in any of the black ethnic groups of Africa
Asian - A person having origins in any of the original peoples of the Far East, Southeast Asia (Including Philippines), or the India subcontinent
Native Hawaiin or Other Pacific Islander - A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Island
Native American - A Person having origins in any of the original people of North America, Central America, South America, or the Caribbean (Tribe/Nation/Pueblo in next question))
Hispanic or Latino/a/x - A person having origins in Mexico, Central America, South America, Puerto Rico, Cuba, Spain, or the Dominican Republic
White - A person having origins in any of the original peoples of Europe, the Middle East or North Africa
Other
Prefer not to disclose