Section 1-760 - Training Roster Form

CMH EMS Education Manual

Course start date:

Course start time:

Course name:

Your LAST name:

Your FIRST name:

Your email address (this is where your completion certificate will be sent:

Agency you are representing:

Your billing address:

If issued a textbook(s), enter the barcode number(s) here:

The complete CMH EMS Education Manual is available online for your reference at The student manual and policies along with each course syllabus are contained in this manual. Signing below indicates you understand you have access to student policies and agree to returning the textbooks indicated above.

Your signature:

Change Log:

DateLink to
Description of change
11/30/-1pdfMoved this section to the online format.
10/28/17pdfUpdated roster form to include agency and make it cleaner to read.
01/19/18pdfUpdated roster form to facilitate new student billing process.
07/17/19Changed document number from 5-700 to 1-760
07/17/19pdfUpdated form to have a separate page for each student to gather more information.

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CMH EMS Education Mission: "Provide state-of-the-art education to develop and support a team of exceptional emergency medical professionals."
Creative Commons License CMH EMS Education Manual by Theron Becker is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Based on a work at Main page.