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Fire and EMS Training Signup
Sign up for PALS Recertification
*Is your department/employer paying for this training? OR Do you hold a rank or position within a Fire/EMS department, and perform duties or responsibilities under the authority of that department?
Yes
No
Student Information
*First Name
*Middle Name or Initial
*Last Name
Previous Last Name
*Cell Phone Number
*Street Address
Apt or Unit #
*City
*State
*Zip Code
*High School Attended
*Year Graduated High School
Year
2027
2026
2025
2024
2023
2022
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1932
1931
1930
1929
1928
1927
1926
1925
1924
*Email Address
Student ID (if known)
*Date of Birth
Month
Month
1
2
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12
Day
Day
1
2
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Year
Year
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
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1952
1953
1954
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1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
*Gender
Male
Female
*Ethnicity
American Indian or Alaskan Native
Asian
Cambodian
Laotian
Vietnamese
Black
Hispanic
White
Native Hawaiian or Pacific Islander
*Highest Grade Completed
Above 12th grade
12th grade
11th grade
10th grade
9th grade
8th grade
Foreign country educated
*Highest Credential Received
No credential (no GED or higher)
Currently in high school
GED
HSED
High school diploma
Some college
Short-term diploma
1 year diploma
2 year diploma (including apprenticeship)
Associate degree
Baccalaureate
More than baccalaureate
*Work Status at Enrollment
Employed full-time
Employed part-time
Under-employed
Unemployed seeking employment
Not in labor market
Dislocated worker
*Do you have a physical or learning limitation?
Yes
No
*Are you a single parent with custodial children under 18 years old?
Yes
No
*Have you ever lost family support, are unemployed and re-entering the labor force?
Yes
No
*Are you receiving Pell, WIA, DVR or W-2 assistance, or is your income below poverty level?
Yes
No
*Is your grade point average (GPA) at or below 1.5?
Yes
No
*Billing Option
Bill to Fire Department/Employer
Bill to Student
Bill to Start College Now Program
(Learn More)
By checking this box, you acknowledge that you are responsible for the
tuition and fees
associated with this course being billed to either yourself, your employer or the Start College Now Program.
It is your responsibility to drop this course if you cannot attend. To drop this course, call the WCTC Enrollment Center at 262-691-5578. Depending on the drop date, you may still be responsible for tuition and fees. Please review our
Tuition Refund Policy
for full details.
Questions?
Contact
Peter Neverman
, 262.691.5541.