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)

substantive Indicate of

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

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.