Section 2-840 - Policy Manual Acknowledgment

CMH EMS Education Manual

My signature below indicates that I have received, read, and understood the policy manual. I agree to follow and adhere to the guidelines set forth by the policy manual, class syllabus, and the instructors. I have received, read, and understood the clinical requirements for the course I am enrolling. I agree to follow and adhere to the guidelines set forth by each course and clinical site. I understand that my final grade will be impacted by my actions or my inactions. I understand that my success or lack thereof is solely my responsibility and not that of the faculty or staff. I take full responsibility for myself and my actions.

As a student, I understand that my performance will be evaluated by faculty, instructors, preceptors, FTOs, and clinical educators in cognitive, psychomotor, and affective domains. I will be informed of the content of these evaluations.

Safety is required of all EMS students. The following are grounds for course failure and may result in dismissal from the course:

Preceptor, FTO, or clinical educator refusal to continue working with the student due to clinical safety issues.
Inappropriate or unsafe behavior during educational activities that indicates impaired judgment and/or unfit condition for the learning environment.
Abuse or inappropriate behavior.
Patient neglect.
Breach of patient confidentiality (HIPAA).
Dishonesty with the patient or own actions.
Refusal to follow directions or commands given by preceptors, FTOs, instructors, faculty, or clinical educators that are meant to ensure your safety, other responder’s safety, or patient safety.
Other unsafe clinical practice as deemed by faculty.

You are enrolling in the following Academy:

Start date:

Your deadlines are listed below. Exceptions are only granted on EXTREMELY extinuating circumstances on a case-by-case basis as long you have been making progress towards goals up until the circumstance (i.e. immediate family lengthy medical crisis, military deployment, etc.). Upon unsuccessfully completing the required activity by the dates below, immediately after that date, you will be listed as “did not complete the program” on NREMT.org and will be unable to take the registry computer-based test or other licensure requirement.

Actual Deadline Date You will be Held to		Typical Length After Start Date
Actual Deadline Date You will be Held to		EMR	EMT	Paramedic	Community Paramedic
	Deadline for all classroom, laboratory, and makeup requirements. Enforced by CMH Education.	4 mo	4 mo	12 mo	4
	Deadline for all clinical hour and skill requirements. Enforced by CMH Education.	N/A	8 mo	20 mo	8
	Deadline for adaptive cognitive exam (Platinum). Enforced by CMH Education.	N/A	1 yr	2 yr	N/A
	Deadline for psychomotor licensing exam (NIEMT). Enforced by NREMT.	N/A	See note	See note	N/A
	Deadline for Computer Based Test (CBT) licensing exam (Pearson/NREMT). Enforced by NREMT.	N/A	See note	See note	N/A

By signing below, I acknowledge that I have read, understood, and agree to all of the above.

Print name:

Signature:

Signature Date:

Change Log:

Date	Link to previous version	Description of change
08/17/16		Added this section.
07/17/19		Changed document number from 4-960 to 2-840
12/05/19	pdf	Added written actual deadline for the students to agree to on the form.
08/21/20	pdf	Moved this section to the online format.
12/29/22	pdf	Added specific deadlines for parts of academy and list of typical deadlines by academy type.

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