EMT Training Program Semi-Annual Report (1002-A)

Todays Date

Individual Completing this form. *

First

Last

Email *

Phone

Reporting Period

Year

Checkboxes *

Period 1 (1/1-6/30)
Period 2 (7/1-12/31)

EMT Training Program Information & Personnel

EMT Training Program

Program Director *

First

Last

Clinical Coordinator *

First

Last

Principal Instructor *

First

Last

Additional Instructors

Name *

First

Last

Indicate below any additional pertinent training program personnel information/changes/notes

Communications/Program Updates/Program Issues

Indicate below any new class starts that occurred during the reporting period (include location, didactic beginning/ending dates and number of enrolled students)

Indicate below any LEMSA or NREMT communications or LEMSA meetings attended during the reporting period

below issues/concerns/notes/etc. number

Indicate below any substantive changes related to the provision of student clinical experience (new/cancelled contracts, significant contract changes/issues)

Indicate below any current issues placing students in the clinical experience phase of their training, and what is being done to address the issue(s) if applicable

Indicate below a summary and outcome of any student complaints received/addressed during the reporting peroid

Indicate below any other pertinent program issues/concerns/notes/etc.