Non-Degree (Guest) Student or Emergency Medical Technician (EMT) or Critical Care Paramedic (CCP) Application

Mercy College welcomes EMT, CCP and non-degree/non-certificate seeking (guest) students to enroll in EMT, CCP or liberal arts and sciences courses on the basis of space availability. Transcripts are not required; however, completion of prerequisite courses or certifications will need to be verified. A maximum of thirty (30) credit hours may be earned as a non-degree seeking student.

EMT, CCP and Non-degree students are not eligible for federal or state financial aid.

Fields marked with a red bar are required.

Last Name

First Name

Middle Name

All Other Last Name(s)

Social Security Number (xxx-xx-xxxx)

Birth Date

Permanent Address

Permanent City

Permanent State

Permanent Zip Code

Permanent County (Iowa Only)

Email Address

Phone Number

Current Address

Current City

Current State

Current Zip Code

Gender

Do you consider yourself to be Hispanic/Latino/Spanish Origin?

Select one or more of the following racial categories to describe yourself:

Citizenship

Country of Citizenship

Is English your native language?

Native Language

Start Term

Are you interested in EMT or CCP?

List below the course(s) you wish to take (course name/number)

Name of High School

Provide the following information for the last college/university you attended and/or from which you have earned a degree, if applicable.

Date Attend Start

Date Attend End

Name of School

State

Degree Earned

Signature

Signature Date